Real-world injection burden, treatment switching, and visual outcomes in diabetic macular edema: a 563-eye cohort study
- 1Department of Ophthalmology, Diyarbakır Gazi Yaşargil Training and Research Hospital, University of Health Sciences
Abstract
Background To evaluate real-world injection burden, treatment switching patterns, and visual outcomes in patients with diabetic macular edema (DME) receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy. Materials and methods This retrospective observational cohort study included 563 eyes with DME treated with anti-VEGF agents and followed for at least 12 months. All eyes received an initial loading phase of three monthly bevacizumab injections followed by a pro re nata regimen. Primary outcomes were the number of injections and outpatient visits during the first year. Secondary outcomes included change in best-corrected visual acuity (BCVA), distribution of visual outcomes, and treatment switching patterns. Multivariable linear regression and generalized estimating equation (GEE) analyses were performed to identify independent predictors of visual outcomes. Results Eyes received a mean of 5.4 ± 2.4 injections and attended 8.0 ± 2.2 visits during the first year. Mean BCVA improved from 0.75 ± 0.43 to 0.59 ± 0.42 logMAR (mean change − 0.16 ± 0.35; P < 0.001). Visual improvement was observed in 60.2% of eyes, stability in 21.7%, and deterioration in 18.1%. Treatment switching occurred in 29.7% of eyes, typically within the first 4–5 months. In multivariable linear regression analysis, baseline BCVA was associated with visual acuity change (β = −0.33, P < 0.001). Treatment switching was associated with visual outcomes in unadjusted analysis but was not independently associated after adjustment. In the GEE analysis accounting for inter-eye correlation, baseline BCVA remained significantly associated with visual acuity change (P < 0.001), whereas injection number (P = 0.527) and treatment switching (P = 0.976) were not associated. Conclusions In real-world clinical practice, anti-VEGF therapy for DME was associated with meaningful visual improvement despite a moderate injection frequency. Visual outcomes were primarily associated with baseline visual acuity rather than treatment intensity. Treatment switching was not independently associated with visual acuity change after adjustment, suggesting that it likely reflects underlying disease refractoriness rather than acting as an independent factor associated with visual outcomes; however, causal inference cannot be established due to the observational study design. These findings underscore the importance of individualized treatment strategies in DME.
Related
- Early clinical outcomes after switching to faricimab in previously treated diabetic macular edema
- Switching to Faricimab in Patients with Chronic Diabetic Macular Edema Refractory to Previous Anti-VEGF Therapy: Morphological and Functional Outcomes Including Optical Coherence Tomography Angiography Parameters
- GLP-1 Receptor Agonist Initiation and Anti-VEGF Treatment Frequency in Diabetic Macular Edema: an IRIS(R) Registry Cohort Study
- Faricimab 6 mg versus aflibercept 8 mg in diabetic macular oedema: an in silico study of anchored efficacy and common-protocol treatment burden
- Early outcomes of switching from bevacizumab to aflibercept-jbvf in exudative macular diseases: a real-world study.
BibTeX
@article{oncul2026realworld,
title = {{Real-world injection burden, treatment switching, and visual outcomes in diabetic macular edema: a 563-eye cohort study}},
author = {Hasan Öncül and Umut Dağ and Hüseyin Dinç and Mehmet Fuat Alakuş},
journal = {BMC Ophthalmology},
year = {2026},
month = jul,
doi = {10.1186/s12886-026-05156-2},
url = {https://doi.org/10.1186/s12886-026-05156-2},
note = {CC BY},
}
RIS
TY - JOUR
TI - Real-world injection burden, treatment switching, and visual outcomes in diabetic macular edema: a 563-eye cohort study
AU - Hasan Öncül
AU - Umut Dağ
AU - Hüseyin Dinç
AU - Mehmet Fuat Alakuş
PY - 2026
DA - 2026/07/01
JO - BMC Ophthalmology
DO - 10.1186/s12886-026-05156-2
UR - https://doi.org/10.1186/s12886-026-05156-2
AB - Background To evaluate real-world injection burden, treatment switching patterns, and visual outcomes in patients with diabetic macular edema (DME) receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy. Materials and methods This retrospective observational cohort study included 563 eyes with DME treated with anti-VEGF agents and followed for at least 12 months. All eyes received an initial loading phase of three monthly bevacizumab injections followed by a pro re nata regimen. Primary outcomes were the number of injections and outpatient visits during the first year. Secondary outcomes included change in best-corrected visual acuity (BCVA), distribution of visual outcomes, and treatment switching patterns. Multivariable linear regression and generalized estimating equation (GEE) analyses were performed to identify independent predictors of visual outcomes. Results Eyes received a mean of 5.4 ± 2.4 injections and attended 8.0 ± 2.2 visits during the first year. Mean BCVA improved from 0.75 ± 0.43 to 0.59 ± 0.42 logMAR (mean change − 0.16 ± 0.35; P < 0.001). Visual improvement was observed in 60.2% of eyes, stability in 21.7%, and deterioration in 18.1%. Treatment switching occurred in 29.7% of eyes, typically within the first 4–5 months. In multivariable linear regression analysis, baseline BCVA was associated with visual acuity change (β = −0.33, P < 0.001). Treatment switching was associated with visual outcomes in unadjusted analysis but was not independently associated after adjustment. In the GEE analysis accounting for inter-eye correlation, baseline BCVA remained significantly associated with visual acuity change (P < 0.001), whereas injection number (P = 0.527) and treatment switching (P = 0.976) were not associated. Conclusions In real-world clinical practice, anti-VEGF therapy for DME was associated with meaningful visual improvement despite a moderate injection frequency. Visual outcomes were primarily associated with baseline visual acuity rather than treatment intensity. Treatment switching was not independently associated with visual acuity change after adjustment, suggesting that it likely reflects underlying disease refractoriness rather than acting as an independent factor associated with visual outcomes; however, causal inference cannot be established due to the observational study design. These findings underscore the importance of individualized treatment strategies in DME.
SN - 1471-2415
ER -