Characterization of poor visual outcomes of diabetic macular edema: the Fight Retinal Blindness! Project

Purpose: To investigate the incidence, characteristics and baseline predictors of poor visual outcomes in eyes with diabetic macular edema (DME) receiving intravitreal therapy in routine clinical practice.

Design: Observational study.

Participants: Treatment-naive eyes starting intravitreal therapy for DME between 2014 and 2018 tracked in the Fight Retinal Blindness! registry. We examined two groups with poor visual outcomes: 1) Those with sustained vision loss of >10 letters from baseline without recovery of visual acuity (VA) or 2) Those with VA10 letter loss was 14% at 2 years while 16% of eyes had VA10 letter loss was (Hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.60-6.44; P10 letter loss (HR, 6.81; 95% CI, 4.11-11.27; P <0.01) and VA<55 letters at 2 years (HR, 4.28; 95% CI, 2.66- 6.89; P <0.01). The other factors related to higher risk of VA<55 letters were older age (HR, 1.02 per year; 95% CI, 1-1.04; P = 0.04) and poor baseline VA (HR, 0.68 per 5 letters; 95% CI, 0.65- 0.72, P 10 letter loss and 16% had VA<55 letters 2 years after starting treatment for DME. Identification of the incidence and predictors of poor outcomes provides more accurate assessment of the potential benefit from intravitreal therapy.