Factors Influencing Treatment of Diabetic Macular Edema

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Rishi P. Singh, MD, discusses new VISTA/VIVID data showing what really influences a patients' likelihood and time to DME resolution when treated with aflibercept.

New data from the American Society of Retina Specialists (ASRS) 2021 Scientific Meeting this weekend bucked clinicians’ perspectives of what baseline factors influence a patients’ treatment of diabetic macular edema (DME).

The new findings from the 2-year VISTA and VIVID trials, presented by Rishi P. Singh, MD, of the Cole Eye Institute at the Cleveland Clinic, observed baseline patient characteristics and vision-related factors and their association with treatment of DME with intravitreal aflibercept injection.Singh and colleagues observed that thicker central subfield thickness (CST) and above-average best corrected visual acuity (BCVA) at baseline were associated with greater time to DME resolution—as well as a lower rate of resolution overall.

In an interview with HCPLive during ASRS 2021, Singh highlighted the observed “disconnect between anatomy and vision” observed in patients with DME from VISTA/VIVID, as well as some of the debunked preconceptions he and colleagues had about DME treatment-mitigating risk factors.

“One of the hypotheses that we had going into the study was that worse diabetic retinopathy severity potentially had a longer time to DME resolution—and in fact, we didn’t see that relationship,” Singh said. “We didn’t see a relationship with hemoglobin in A1c, so diabetes control (and DME).”

Singh also discussed the significance of the findings on general ophthalmology prescribing and patient follow-up.

“I think as a whole in the total study, it really helps people understand the duration of treatment needed to get to a good, steady state, and it allows clinicians to understand the needs of the patients depending on where they sit in the baseline factors,” Singh said.