Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort

Abstract

Purpose: To evaluate how the monitoring and treatment for diabetic macular edema (DME) has changed in a national sample.

Design: Retrospective cohort study.

Setting: Administrative medical claims data from a large, national U.S. insurer.

Study population: Beneficiaries of a U.S. insurance company.

Observation procedures: All incident cases of DME were found. Those in years 2002/3, 2006 and 2010 were followed for a 2-year observation period and those from 2009, 2010 and 2011 for a 1-year observation period.

Main outcome measures: Types and frequencies of treatment were tallied and compared over each of the cohorts.

Results: Two-year cohorts had 233, 251 and 756 patients in 2002/3, 2006 and 2010 respectively. One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (anti-VEGF) (p<0.001). The highest use of anti-VEGF agents in any of the cohorts was in the 2011 1-year group that only averaged 3.78 injections. Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of DME patients receiving anti-VEGF therapy in any of the cohorts.

Conclusion: Regardless of treatment modality (laser or injection) DME patients received vastly fewer treatments than patients in randomized control trials. Despite the proven superior visual outcomes of anti-VEGF agents over focal laser in DME, focal laser was still used more frequently.

Fig 1. Flow chart for inclusion/exclusion criteria for each of the final cohorts.

*Diagnoses included proliferative retinopathies, sickle cell disease, vein occlusions, pathologic myopia, retinoschisis, age-related macular degeneration, cystoid macular edema, all uveitides, glaucoma and intraocular surgery within 90 days of index date. **Diagnoses included proliferative retinopathies, sickle cell disease, vein occlusions, pathologic myopia, retinoschisis, age-related macular degeneration, cystoid macular edema, all uveitides, and glaucoma.