Anti-VEGF injections are a mainstay of management for various retinal conditions. With diabetic macular edema, patients may receive injections on a fixed schedule, but a new study published in
Ophthalmology Science assessed whether outcomes upon treatment cessation would be adequate and remain stable.1
The retrospective investigation included 81 eyes (62 patients) who met inclusion criteria and had a follow-up of ≥24 months; treatment interruption was defined as a treatment-fee interval of ≥25 weeks after the last injection, happening for any reason. With a maximum follow-up of up to 10 years and a median of five, patients received 22.6 ±14.9 (median 20) injections. One planned treatment cessation occurred in 70.4 percent of patients and four eyes experienced an unplanned interruption of treatment. Cessation was seen in 65.4 percent of eyes at a median of 42 weeks after treatment initiation for 106.2 ±110.4 (median 54) weeks. One eye (1.9 percent) had treatment cessation due to wishing to stop treatment against medical advice, was physician-driven in 38 eyes (71.7 percent) that had stable visual acuity despite persisting residual retinal fluid seen with OCT and was OCT-driven in 14 eyes (26.4 percent) with no intraretinal fluid on OCT. Overall, cessation was seen in 70 percent of DME eyes during the first year.
Due to patients who had treatment cessation having no negative impact on long-term outcomes, the authors of the study write that “this calls for a discussion about a possible systematic assessment of disease stability by omitting a single injection in eyes with stable retinal fluid.”
The authors wrote that treatment cessation was possible for almost two years (106 weeks), underscoring a robustness of stability under the persisting fluid-tolerant treatment protocol—mapping onto a relevant reduction in treatment burden for patients. After an average of 65 weeks, eyes became widely dry with tolerance of excess central retinal thickness of ≤10 percent, indicative of a generally favorable anatomic response after intensive treatment (mean 7.7 injections) in the first year. They also report only a small 5 percent of patients being lost to follow-up over a mean of 5.7 years.
Because of the nature of these results, the authors contend that “stable fluid may be tolerated which triggers a reconsideration of the best treatment approach. The currently fluid-driven protocol is not necessarily the ideal patient-supported one.”
Instead, they offer the suggestion that “eyes with a supportable amount of persistent, but stable fluid may benefit from an individualized strategy with ‘diagnostic’ treatment interruption.” They highlight that this strategy differentiates DME from non-proliferative age-related macular degeneration, in which only complete dryness indicates control of disease activity.
REFERENCE
1. Saucedo L, Pfister IB, Schild C, et al. Treatment cessation in patients with diabetic maculopathy under intravitreal anti-VEGF therapy following a treat-and-extend protocol. Ophthalmol Sci. June 2, 2025. [Epub ahead of print].
Celebrating a Rich Career This issue of Retina Specialist is special in a couple of ways. This specific issue marks Rich Kirkner’s last one as Editor, as he’s moving on to a well-earned retirement. Since the magazine’s inception, it’s been Rich’s baby. He’s worked tirelessly with retinal specialists to select the best topics and then used his keen editorial eye to make sure each topic was thoroughly and compellingly explored. Rich honed these abilities over nearly 40 years of working in various publications, from business and general surgery to eye care. He’s won 31 journalism awards and has overseen magazines that ranked #1 in their field. Rich was multi-tasking before it was even a term: writing and editing articles; managing large staffs of editors and art directors; managing medical conferences and staying on top of complex medical topics. I’ve known him personally for many of these years—having started on Review of Ophthalmology, a sister publication, as a junior editor back in the 1990s—and never once did he lose his trademark wry sense of humor, or the respect of his staff. His work always made everyone else’s work better. So, Rich, from all of us at Review and Jobson Publishing, thank you for all you’ve done and we wish you nothing but the best in your retirement! Also, in addition to Rich’s riding off into the sunset, 2025 marks RS’ 10th year of publication (also thanks to Rich’s efforts). Thanks to all of you for your loyal readership and contributions over the past decade. Here’s to many more years! |
AI May Help Increase DR Patient Follow-ups
Catching diabetic retinopathy as early as possible is key to preserving patients’ vision. But despite the frequent implementation of large-scale screening efforts, adherence to annual eye exams still lag, with rates presently at 67 percent in high-income countries and 39 percent in low- and middle-income countries, according to research. Those patients with referable DR have also been slow to attend referral appointments.
To probe for ways to improve adherence, a group of researchers recently compared human graders and computer-based artificial intelligence assessment of images in diabetic retinopathy screening programs. Their review study published recently in Eye showed that AI algorithms are associated with an increased uptake in follow-up exams because they give patients actionable information right away.1
The researchers screened articles in several major health sciences databases. Their review yielded data from 20,108 patients with diabetes across six studies, 6,476 of which were graded using artificial intelligence and 13,632 who were graded by humans. The random effects model showed that initial AI assessment for diabetic retinopathy significantly increased the number of scheduled follow-up appointments (OR 1.89). Patients under 21 in particular demonstrated higher uptake (OR 11.06) compared with adults (OR 2.75).
“AI-assisted DR screening allows real-time classification of severity of DR at the point-of-care, in any clinical setting, irrespective of availability of skilled ophthalmic personnel; this in turn allows patients to be informed of any need for onward referral sooner than can be achieved with human graders,” the researchers explained in their paper. “AI based DR screening systems accelerate the analysis of fundus images and provide DR grading results faster than human grader-based systems.”
The researchers concluded that this increased uptake in follow-up exams is “likely due to instant results being made available with AI-based algorithms when compared to a delay in the communication assessment outcomes achieved with human graders.” RS
REFERENCE
1. Rahmati M, Smith L, Prabhath M, et al. Artificial intelligence improves follow-up appointment uptake for diabetic retinal assessment: A systematic review and meta-analysis. Eye 2025. [Epub May 30, 2025].
