Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India

Abstract

Purpose: The aim of this study was to report visual and anatomical outcomes following treatment for diabetic macular edema (DME) in clinical practice in India. Methods: Retrospective chart review of patients with DME who were initiated on treatment and followed up for at least 1 year at 9 tertiary eye care centers during 2016–2017 was performed. Data on demographics, systemic illnesses, visual acuity and anatomical characteristics of DME, treatment history were collated and analyzed for change in visual acuity level and central macular thickness at 1 year. Results: A total 1853 patients were diagnosed with treatable DME during study period, 1315 patients were treated and 556 patients (1019 eyes) followed up at one year. Although patients achieved significantly better anatomical outcome (central macular thickness of <300μ in 32.3% at baseline compared to 60.7% at 1 year, P < 0.001), visual impairment due to DME did not differ from baseline (mild visual impairment in 53.2% at baseline compared to 56% at 1 year, P = 0.7). Cystoid type of DME was the most common phenotype (432/1019, 42.4%) followed by spongy type (325, 31.9%) and cystoid plus spongy type (138, 13.5%). Bevacizumab monotherapy was the most common (388/1019, 38.1%) treatment followed by combination therapy (359, 35.2%). Mean number of anti-VEGF injections received per eye in a year was 2.1 (SD ± 0.9). Conclusion: Only about a third of treated DME patients complete one year follow up in India. Most patients receive suboptimal number of treatments. Treated DME cases largely show better anatomical outcome but not a better functional outcome.

Diabetic Retinopathy and Diabetic Macular Edema in People With Early-Onset Diabetes

“…This finding is comparable to the study by Rajalaxmi et al ( 14), who reported a prevalence of 12.7% in a similar cohort of patients diagnosed with diabetes at a young age. In a recently published article by Kulkarni et al (15), the prevalence of treatable DME was only 3.1% in a cohort of patients >40 years of age with diabetes. Thus, the prevalence of DME and the need for treatment of DME are higher in young people with diabetes compared with older people with diabetes.…”

Geriatric conditions and quality of life among older adults with diabetes

“…A study in Malaysia suggested an 18.8% prevalence of diabetes associated falls among the elderly. [14] Persons with type 2 diabetes are at increased risk of falling compared to similar aged healthy adults. A combination of diabetes and age (>65 years) increases the risk of falling 17fold.…”

EANet: Multiscale autoencoder based edge attention network for fluid segmentation from SD‐OCT images

“…Recent studies have proven that around seven anti‐VEGF injections should be taken per year for desirable results 8 . With an estimated cost of the cheapest anti‐VEGF injection of INR 7000, the expenses can be as high as INR 42000 to 70 000 (USD 575–1000) per year 9 . Patients who undergo anti‐VEGF treatment must be monitored regularly to track the effectiveness, thus making the treatment very expensive.…”