This US-based retrospective cohort study evaluated vision and anatomic outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF therapy who were lost to follow-up (LTFU) and stopped treatment for several months.
Study design
Records from 90 eyes of 73 patients with nonproliferative diabetic retinopathy (NPDR) and DME who were LTFU for ≥6 months were reviewed. The mean LTFU interval was 322 days, and the follow-up period after return was 502 days. The primary outcomes were change in mean visual acuity (VA) and central foveal thickness (CFT) at the return and final follow-up visits vs. the visit just prior to LTFU.
Outcomes
Both VA and CFT were significantly worse at the first return visit than at the visit prior to LTFU (VA 20/52 vs. 20/69, respectively; CFT 270 vs. 305 microns, respectively). However, no significant differences were noted in either VA or CFT between the final follow-up visit and the visit prior to LTFU.
Limitations
Although study results suggest that eyes experienced modest vision loss with an LTFU period of ≥6 months, with ultimate recovery of vision at final follow-up, the overall sample size was relatively small. The mean glycated hemoglobin of the study participants was 8.2%, and results may not be applicable to patients with worse systemic glycemic control. In addition, eyes were not compared with a control group of eyes without treatment interruption, and thus potential losses in vision and anatomic integrity cannot be ascertained. Notably, this study included only eyes with NPDR, and the sample size was not powered to detect differences between mild, moderate, and severe disease.
Clinical significance
Periods of LTFU may be encountered for a variety of reasons, including most recently the COVID-19 pandemic. In this series of eyes with NPDR and DME, vision and anatomic outcomes achieved with anti-VEGF treatment were ultimately recovered after treatment was reinitiated. Eyes with DME treated with anti-VEGF may fare better after periods of LTFU than eyes with other indications, such as neovascular AMD. These findings may help ophthalmologists guide patient expectations following periods of LTFU, for whatever reason, in eyes with NPDR and DME.