Pre-Questions

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Highlights From DME Retina Edge Expert Roundtable Discussion
 
1. In general, how many injections of an anti-VEGF agent should a patient be given before identifying the patient as a nonresponder?
1
2 to 3
4 to 5
6 or more
2. What was the median number of injections patients received in the Protocol T study at 1 year?
3 to 4
5 to 6
7 to 8
9 to 10
3. Which of the following statements is supported by the Protocol T study results?
Aflibercept was more effective at improving vision than either bevacizumab or ranibizumab.
Ranibizumab was more effective at improving vision than bevacizumab.
At worse levels of initial visual acuity, aflibercept was more effective at improving vision
      than either bevacizumab or ranibizumab.
At worse levels of initial visual acuity, ranibizumab was more effective at improving vision
      than bevacizumab.
4. Anti-VEGF treatment failure may be defined by
Eyes not being completely dry after 9 injections.
Eyes requiring 1 or more laser treatments.
Visual improvement of less than 10 letters.
Stable visual acuity relative to baseline of less than 20/20.
5. Bevacizumab was inferior to both ranibizumab and aflibercept in
Visual acuity outcomes.
Central subfield thickness outcomes.
Median number of injections required in 1 year.
Total number of laser treatments in 1 year.

Case Discussion 1: A gentleman who has a 10-year history of diabetes presented with bilateral nonproliferative disease: 20/50 in the right eye and 20/40 in the left eye.

6. What would you do?

Given the 20/50 vision in his right eye, I would use aflibercept and do bilateral injections.
If insurance coverage was an issue, I would use bevacizumab and assure the patient that
      he still has an excellent chance of doing well visually.
If insurance coverage was an issue, I would use ranibizumab and assure the patient that
      he still has an excellent chance of doing well visually.
All of the above are appropriate choices.
Case Discussion 2: A 58-year-old woman has had type 2 diabetes for 11 years and no history of prior DME treatment. Upon exam, she had moderate nonproliferative diabetic retinopathy in both eyes, with vision of 20/50 in the right eye and 20/16 in the left eye. Right eye OCT CST was 519 µm; left eye OCT CST was 508 µm.in the left eye. Right eye OCT CST was 519 µm; left eye OCT CST was 508 µm.

7. What first-line treatment would you recommend?
Aflibercept bilaterally.
Aflibercept in the right eye; watch the left eye for a drop in visual acuity and then treat
      with an anti-VEGF.
Aflibercept in the right eye; laser in the left eye.
Aflibercept in the right eye; steroid implant in the left eye.
Case Discussion 3: A 52-year-old woman with moderate cataracts and a history of proliferative diabetic retinopathy presented with blurry vision in both eyes: 20/80 in the right eye and 20/60 in the left eye. Upon exam, she was found to have center-involved DME in both eyes. The fluorescein angiogram showed leakage in both eyes following 2 injections with bevacizumab.

8. What should you do?
Switch to aflibercept.
Switch to ranibizumab.
Keep treating with bevacizumab for at least two more injections.
Treat with laser.