Dataset Information

Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

ABSTRACT:

Aims/introduction

In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME.

Materials and methods

This is a real-world clinical study including 1,552 patients with treatment-naïve center-involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55-64; C3, 65-74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years.

Results

From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were -0.01 in C1, -0.06 in C2, -0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were -136.2 μm in C1, -108.8 μm in C2, -100.6 μm in C3, and -89.5 μm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti-VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001).

Conclusions

Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real-world clinical practice.

SUBMITTER: Kusuhara S

PROVIDER: S-EPMC9340861 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

Kusuhara Sentaro S Shimura Masahiko M Kitano Shigehiko S Sugimoto Masahiko M Muramatsu Daisuke D Fukushima Harumi H Takamura Yoshihiro Y Matsumoto Makiko M Kokado Masahide M Kogo Jiro J Sasaki Mariko M Morizane Yuki Y Utsumi Takuya T Kotake Osamu O Koto Takashi T Terasaki Hiroto H Hirano Takao T Ishikawa Hiroto H Mitamura Yoshinori Y Okamoto Fumiki F Kinoshita Takamasa T Kimura Kazuhiro K Yamashiro Kenji K Suzuki Yukihiko Y Hikichi Taiichi T Washio Noriaki N Sato Tomohito T Ohkoshi Kishiko K Tsujinaka Hiroki H Kondo Mineo M Takagi Hitoshi H Murata Toshinori T Sakamoto Taiji T

Journal of diabetes investigation 20220509 8

<h4>Aims/introduction</h4>In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME.<h4>Materials and methods</h4>This is a real-world clinical study including 1,552 patients with treatment-naïve center-involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55-64; C3, 65-74; and C4, ≥75 years). ...[more]

PMID: 35389565

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Project description:BackgroundPost-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME.MethodsThis retrospective claims analysis identified patients from the IBM® MarketScan® Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models.ResultsTreatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 [30%]), topical nonsteroidal anti-inflammatory drug drops (321 [27%]), and intraocular or periocular injectable steroids (189 [15%]). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7-6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8-3.2), adding $371 in total cost (95% CI: $332 - $410).ConclusionsPCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.

Dataset Information

Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

Aims/introduction

Materials and methods

Results

Conclusions

Publications

Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

Similar Datasets

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