DME patients returning with stable vision after a lapse gain little from anti-VEGF retreatment

Design

Retrospective nationwide registry cohort

Population

976 patients with centre-involved DME returning after 6 months or more lost to follow-up

Primary outcome

Visual and anatomical response to anti-VEGF retreatment

Effect

Visual gain 32.7% (stable) vs 62.0% (declined); OR 0.29 (95% CI 0.22 to 0.38)

This retrospective cohort from a nationwide registry, published in June, followed 976 patients with centre-involved diabetic macular oedema who returned after being lost to follow-up for at least six months, median about eight and a half months. All had visual acuity below 20/25 and central foveal thickness of 250 µm or more on return.

Vision had held steady in 45.8% and worsened in 54.2%. After about a year of retreatment, visual gain occurred in 32.7% of those with stable vision against 62.0% of those whose vision had worsened. Thickness fell by at least 10% in 56.4% against 63.2%. Adjusted odds of visual gain were about 70% lower in the stable group (OR 0.29, 95% CI 0.22 to 0.38). Patients returning with stable vision of 20/50 or better did not gain vision despite anatomical improvement. More injections during retreatment were associated with better response.

The design cannot say what would have happened without retreatment, and patients with stable vision have less room to improve. Even so, the finding is relevant wherever loss to follow-up is common, as it is in many Indian retina clinics because of cost and travel.

For a patient who returns with stable, reasonably good vision, the decision to restart injections deserves a frank conversation about likely benefit rather than an automatic restart.

• Compare vision on return with the last recorded value before the lapse.
• Expect less visual gain from retreatment when vision has held steady during the lapse.
• Discuss expected benefit openly with patients returning at 20/50 or better.
• Where retreatment is chosen, plan an adequate number of injections; response rose with more.
• Build reminders and follow-up support to reduce lapses in the first place.

Why it matters

Injections cost money and visits, and for some returning patients the expected gain in vision is small.

Don't overread it

This retrospective study had no untreated comparison, so it cannot show that retreatment is without value for anatomy or long-term stability.

The statistics, in plain English

An odds ratio of 0.29 means the odds of visual gain were about 70% lower in the stable-vision group. Part of this is a ceiling effect: eyes that see better have less room to improve.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.