Diabetic macular edema (DME) patients receiving anti-vascular endothelial growth factor (anti-VEGF) injections who are not satisfied with their short-term results shouldn’t lose hope. Researchers have found that eyes with less than a five-letter gain at 12 weeks often still have good visual acuity (VA) at two years (20/25 to 20/32) without switching therapies.

The study analyzed data of 616 eyes from the DRCR.net Protocol T study, a randomized clinical trial assessing three anti-VEGF agents (2.0mg aflibercept, 1.25mg bevacizumab and 0.3mg ranibizumab) for treatment of DME. Among the eyes with a less than five-letter gain at 12 weeks, the percentages gaining 10 or more letters from baseline at two years were 42%, 31% and 47%, respectively, for each drug.

Together with other baseline predictors, the baseline VA and 12-week VA response to treatment accounted for only about one-third of the variability in change in VA by two years.

Researchers conclude that their findings do not support switching therapies in eyes that do not have a positive early response to anti-VEGF therapy for DME.

Bressler NM, Beaulieu WT, Maguire MG, et al. Early response to anti-vascular endothelial growth factor and two-year outcomes among eyes with diabetic Macular edema in Protocol T. Am J Ophthalmol. August 2, 2018. [Epub ahead of print].