Anti-VEGF therapy may not improve visual acuity in diabetic retinopathy:Study

Anti-VEGF therapy may not improve visual acuity in diabetic retinopathy:Study

Early treatment with anti-vascular endothelial growth factor (VEGF) injections may slow diabetic retinopathy, according to results from a recent intermediate study published in JAMA Ophthalmology. However, the treatment’s effect on vision, including changes in visual acuity and vision loss,  was similar to standard treatment which usually begins only after the onset of late disease.

Diabetic retinopathy is a complication of diabetes that causes damage to the blood vessels of the light-sensitive tissue in the retina. In the early stages of diabetic retinopathy, called non-proliferative diabetic retinopathy, changes in the eye’s blood vessels are visible to clinicians but generally do not affect sight.

In the advanced stages, people can develop proliferative diabetic retinopathy, where retinal blood vessels grow abnormally, and/or diabetic macular oedema, where fluid leaks out of the retinal blood vessels. Both can lead to vision loss and blindness. Treatment, such as with anti-VEGF drugs, can slow or prevent vision loss in people with proliferative diabetic retinopathy or diabetic macular oedema if treatment occurs promptly.

In this study, participants with non-proliferative diabetic retinopathy either received injections of a commercially available anti-VEGF – aflibercept (Eylea) or a sham injection. They were examined at one, two, and four months, and then every four months for two years, receiving aflibercept or sham injection at each visit.

The researchers tracked their visual acuity and the severity of their diabetic retinopathy. If the disease progressed, regardless of whether they were in the treatment or sham group, participants were given aflibercept more frequently as is given in standard practice. If their condition did not improve with additional anti-VEGF treatment, participants could be given treatments such as laser photocoagulation or surgery if necessary.

The study included 328 participants. In two years, the rate of proliferative diabetic retinopathy development was 33% in the control group, compared with 14% in the treatment group. Likewise, the rate of development of diabetic macular oedema affecting vision was 15% in the control group, compared with 4% in the treatment group. However, loss of visual acuity was essentially the same between the two groups at two years, suggesting that standard treatment at the appearance of proliferative diabetic retinopathy or diabetic macular oedema affecting vision is sufficient to prevent further vision loss at this time point.

“Although we did not see any difference in visual outcomes at two years, the four-year follow-up is going to be very important,” said Jennifer Sun, M.D., M.P.H., Joslin Diabetes Center, Harvard Medical School, Boston, chair of Diabetes Initiatives for the Network. “We look toward the four-year data to see whether reducing rates of diabetic retinopathy worsening will lead to long-term improvement in visual outcomes.”

The Clinicaltrials.gov identifier for this study is NCT02634333.