Using a specific anti-vascular endothelial growth factor (VEGF) drug in patients with moderately severe to severe nonproliferative diabetic retinopathy (NPDR) can result in a ≥2-step improvement in diabetic retinopathy severity scores (DRSS) in almost 60% of those treated, according to results of the PANORAMA study presented during this year’s American Society of Retina Specialists meeting.
These study results add to the ever-growing body of evidence that suggest anti-VEGF injections can lead to “robust” improvements in DR, said Charles C. Wykoff, MD, PhD, Houston. In fact, the 2018 PAT Survey 1 found intravitreal anti-VEGF agents are the overwhelming first choice by retinal specialists for treating diabetic eye diseases.
In the early 1990s, the Early Treatment of Diabetic Retinopathy Study standardized how to quantify and qualify NPDR and created a threshold for its treatment, Dr. Wykoff said.
“That standardization allowed different researchers and clinicians to begin to speak the same language about DR but maybe even more importantly, the designation of an eye within this quantitative scale has proven to be predictive of DR progression itself,” he said.
Greater DR scores confer a greater chance of converting to PDR, he added. Higher scores are also associated with decreased vision-related quality of life measures, he said, making earlier intervention a key component to consider in management.
“Patients with center-involved diabetic macular edema (DME) with visual acuity loss warrant intervention,” he told attendees. “Those with high-risk PDR warrant intervention as well.” But other scenarios are not as clear-cut including patients with non-center involved DME and those with center-involved DME but without specific visual acuity loss.
“But what about nonproliferative disease?” he said. “There is little data available to guide discussion on when to treat these patients and how often.”
To that end, Dr. Wykoff and colleagues wanted to evaluate “the efficacy and safety of intravitreal aflibercept injection for treatment of moderately severe to severe NPDR in eyes that had not yet developed DME.”
Dr. Wykoff is a consultant for Allergan, Alimera, Bayer, Clearside, DORC, Genentech, ONL Therapeutics, and Regeneron.
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