Retreating DMO after lost follow-up rarely improved vision that had held steady

Design

Retrospective nationwide registry cohort

Population

976 patients with centre-involving DMO returning after ≥6 months lost to follow-up

Primary outcome

Visual and anatomical response to anti-VEGF retreatment

Effect

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

Patients with diabetic macular oedema often drop out of injection schedules. This retrospective registry study included 976 patients with centre-involving oedema who returned after six months or more away (median 259 days), and compared those whose vision had held steady with those whose vision had fallen.

About 46% returned with stable vision. On restarting anti-VEGF, vision improved in 32.7% of them, against 62.0% of those who returned with worse vision (adjusted OR 0.29, 95% CI 0.22-0.38). Anatomical response was also slightly lower. Patients who returned stable at 20/50 or better did not gain vision despite thinner maculae. More injections during retreatment were associated with better response in both groups.

The data are retrospective and the comparison is between groups that differed by definition. They do not show that withholding treatment is safe.

For a returning patient with good, stable vision, the expected visual gain from restarting injections is small; discuss this frankly and weigh retreatment, monitoring or alternatives case by case.

• Patients returning with stable vision gained vision on retreatment in only about a third of cases.
• Those returning at 20/50 or better did not gain vision despite anatomical improvement.
• Patients returning with worse vision gained in about six in ten.
• Set expectations before restarting injections in a returning patient with good vision.
• Build recall systems to reduce loss to follow-up in the first place.

Why it matters

It changes the conversation with a returning patient from catching up on injections to what each injection can realistically achieve.

Don't overread it

This retrospective study does not show that observation without injection is safe for these eyes.

The statistics, in plain English

An odds ratio of 0.29 means much lower odds of visual gain in the stable group. Part of this is a ceiling effect: eyes that already see well have less room to improve.

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