Visual Outcomes in the Management of Diabetic Maculopathy in Central Australia.

Abstract

PURPOSE:

In major urban centres and high-resource settings, treatment of diabetic maculopathy with anti-Vascular Endothelial Growth Factor (VEGF) injections has largely displaced laser treatment. However, intravitreal therapy alone requires frequent follow-up, a barrier to adherence in remote Australia. We report vision outcomes of phased diabetic maculopathy treatment in remote Central Australia for maculopathy using laser and, in a subset, supplementary injection treatment.

METHODS:

We audited clinical records of patients undergoing laser treatment for diabetic maculopathy between 2001 and 2013 at an ophthalmology service based at Alice Springs Hospital, a regional hub in remote Australia. All patients receiving macular laser treatment were included, and some required supplementary injection(s). The primary outcome measure was change in best-corrected visual acuity [BCVA] from baseline treatment.

RESULTS:

Of 338 maculopathy-treated patients, 88% were indigenous and 39% were male. Of 554 maculopathy laser-treated eyes, 118 (21%) received supplementary injection/s. In the laser treatment phase, median BCVA was 78 letters at baseline (interquartile range 62-80) and decreased by a median of two letters at final visit. In the subset who underwent subsequentinjection treatment, BCVA was 60 letters at first injection, with a median five-letter increase by final visit. Overall outcomes were similar in Indigenous and non-Indigenous Australians. Predictors of reduction in BCVA in the macular laser treatment phase were better baseline BCVA, older age, and PRP treatment (all p < .005).

CONCLUSION:

Laser treatment for diabetic maculopathy preserved vision in Central Australia, where barriers to follow-up can preclude regular injections. Supplementary injections stabilized vision in the laser-resistant subset.

• Authors: Pavani Kurra, Laima Brazionis, Jesse Gale, Katie Chen, Stewart Lake, Kristy P Robledo, Tim Henderson
• Journal: Ophthalmic epidemiology (Ophthalmic Epidemiol) Vol. 27 Issue 4 Pg. 265-271 (08 2020) ISSN: 1744-5086 [Electronic] England
• PMID: 32070176 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiogenesis Inhibitors
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Receptors, Vascular Endothelial Growth Factor

Topics

• Adult
• Aftercare
• Angiogenesis Inhibitors (administration & dosage, therapeutic use)
• Australia (epidemiology)
• Bevacizumab (administration & dosage, therapeutic use)
• Diabetes Complications (epidemiology)
• Diabetes Mellitus (epidemiology, ethnology, physiopathology)
• Diabetic Retinopathy (diagnosis, etiology, therapy)
• Female
• Humans
• Intravitreal Injections
• Laser Therapy (methods, statistics & numerical data)
• Light Coagulation (methods)
• Macular Degeneration (diagnosis, etiology, therapy)
• Male
• Medical Audit (methods)
• Middle Aged
• Patient Compliance
• Receptors, Vascular Endothelial Growth Factor (antagonists & inhibitors)
• Retrospective Studies
• Vascular Endothelial Growth Factor A
• Visual Acuity (drug effects)