RWC 2024: What if diabetic retinopathy patients are lost to follow-up?

J. Fernando Arevalo, MD, PhD, FACS, FASRS, spoke about a recent study looking at what happens to patients with diabetic retinopathy who are lost to follow-up. He presented this research at the 2024 Retina World Congress meeting in Fort Lauderdale, Florida.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

J. Fernando Arevalo, MD, PhD, FACS, FASRS:

Hello, my name is Fernando Arevalo, and I'm a professor of ophthalmology at Johns Hopkins University and Wilmer Eye Institute, the Chairman of the Department of Ophthalmology at Bayview Medical Center at Hopkins, and part of the retina division and uveitis and oncology specialist. We're here at the Retina World Congress. It's been a fantastic meeting. I had the honor to present on patients that were lost to follow-up, patients with proliferative diabetic retinopathy.

So background, patients that are treated for proliferative diabetic retinopathy have basically 2 options. They can be treated with intravitreal injections or panretinal photocoagulation based on the results of protocol S. However, protocol S has started a trend for patients with PDR to be treated with anti-VGF injection, especially in the United States, but also worldwide. In addition, protocol S demonstrated that there was a significant number of patients that were lost to follow-up, and that was shown on the 5-year results that were published. So we wanted to answer the question of, what happens if patients are lost to follow up?

And we looked at some studies from Mark Johnson and [inaudible] from Will's showing that patients that are lost to follow-up. If you compare when they are treated with anti-VEGF injections alone to panretinal photocoagulation, patients that are injected with intravitreal injections alone have a higher chance of developing significant complications, including vitreous hemorrhage, traction, retinal detachment, and neovascular glaucoma that lead to vision loss.

So the Pan-American cohort, the retina study group, wanted to look at this issue. And we started [with] patients treated with antiangiogenics for PDR with 24 months of follow-up. So we started 267 patients, 307 eyes that were treated with anti-VGF for PDR and divided patients in 2 groups. Half of the patients were treatment naive and half of the patients had been treated with a previous panretinal photocoagulation. What we found was that patients that were treated with been retinal photocoagulation previously, had a very good response to anti-VEGF therapy and regression of neovascularisation in about 75% of the cases, while patients that were treated with anti-VEGF, and were treatment naive, and no laser previously, those cases responded only in about 15% of the cases, meaning that they ended up requiring laser photocoagulation or vitrectomy. We think that our results indicate that patients that have proliferative diabetic retinopathy, if treated with anti-VEGF alone need to be followed very closely. This is critical, because if they have recurrence of neovascularization, they may have significant complications and visual loss.

We suggest that a combined paradigm of treating patients with PDR with laser photocoagulation and anti-VEGF therapy should be started in a prospective randomized clinical trial.