Visual Outcomes in the Management of Diabetic Maculopathy in Central Australia

ABSTRACT

Purpose:

In major urban centres and high-resource settings, treatment of diabetic maculopathy with anti-Vascular Endothelial Growth Factor (VEGF) injections has largely displaced laser treatment. However, intravitreal therapy alone requires frequent follow-up, a barrier to adherence in remote Australia. We report vision outcomes of phased diabetic maculopathy treatment in remote Central Australia for maculopathy using laser and, in a subset, supplementary injection treatment.

Methods:

We audited clinical records of patients undergoing laser treatment for diabetic maculopathy between 2001 and 2013 at an ophthalmology service based at Alice Springs Hospital, a regional hub in remote Australia. All patients receiving macular laser treatment were included, and some required supplementary injection(s). The primary outcome measure was change in best-corrected visual acuity [BCVA] from baseline treatment.

Results:

Of 338 maculopathy-treated patients, 88% were indigenous and 39% were male. Of 554 maculopathy laser-treated eyes, 118 (21%) received supplementary injection/s. In the laser treatment phase, median BCVA was 78 letters at baseline (interquartile range 62–80) and decreased by a median of two letters at final visit. In the subset who underwent subsequentinjection treatment, BCVA was 60 letters at first injection, with a median five-letter increase by final visit. Overall outcomes were similar in Indigenous and non-Indigenous Australians. Predictors of reduction in BCVA in the macular laser treatment phase were better baseline BCVA, older age, and PRP treatment (all p < .005).

Conclusion:

Laser treatment for diabetic maculopathy preserved vision in Central Australia, where barriers to follow-up can preclude regular injections. Supplementary injections stabilized vision in the laser-resistant subset.

KEYWORDS:

• Anti-VEGF injections
• Avastin
• Bevacizumab
• diabetic maculopathy
• diabetic retinopathy
• laser photocoagulation

Acknowledgments

Professor Hugh Taylor for practical advice and manuscript review, Dr Rosie Dawkins and Dr John Landers for their valuable input during the study.

Conflicts of interest

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Additional information

Funding

The National Health and Medical Research Council Centre for Research Excellence (NHMRC CRE) in Diabetic Retinopathy and The Fred Hollows Foundation.