In this issue of JAMA Ophthalmology, Wykoff and colleagues1 report outcomes of a subset of eyes initially randomized to laser photocoagulation for treatment of center-involving diabetic macular edema in each of 2 multicenter clinical trials. These eyes met criteria for “rescue” treatment with intravitreous aflibercept because of loss of vision after macular laser treatment for diabetic macular edema. The average visual acuity improved by approximately 3 lines (15 letters) from the time of the initiation of treatment with aflibercept. However, despite this improvement, the average visual acuity at 100 weeks was more than 1 line worse than the average for all of the patients randomized to aflibercept at baseline.2 Wykoff and colleagues1 concluded that treatment with aflibercept led to substantial improvement in visual acuity and that delaying the initiation of treatment with aflibercept may limit the amount of improvement in vision because of damage caused by persistent retinal edema. These conclusions have implications for patient management and therefore warrant scrutiny.
Maguire MG. Further Scrutiny of Vision Outcomes When Aflibercept Is Used as Rescue Treatment for Eyes With Diabetic Macular Edema Treated With Laser. JAMA Ophthalmol. Published online December 22, 2016. doi:10.1001/jamaophthalmol.2016.4936