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Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes
  1. Thomas A Ciulla1,2,
  2. John S Pollack3,4,
  3. David F Williams5,6
  1. 1Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  2. 2Retina Service, Midwest Eye Institute, Indianapolis, United States
  3. 3Rush University, Chicago, Illinois, USA
  4. 4Illinois Retina Associates, Chicago, IL, United States
  5. 5University of Minnesota, Minneapolis, Minnesota, USA
  6. 6VitreoRetinal Surgery, PA, Minneapolis, MN, United States
  1. Correspondence to Dr Thomas A Ciulla, Indiana University School of Medicine, Indianapolis, Indiana, USA; thomasciulla{at}


Background/Aim To assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO).

Methods Retrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health).

Results At 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013–2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10–13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters.

Conclusion In clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.

  • treatment medical
  • retina
  • macula

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JFP and DFW are co-founders of Vestrum Health.

  • Patient consent for publication Not required.

  • Ethics approval The Indiana University Institutional Review Board exempted this study from review because it only involved assessment of existing de-identified data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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