The impact of demographic factors on clinical outcomes and loss to follow-up in diabetic macular edema and diabetic retinopathy following anti-vascular endothelial growth factor therapy or panretinal photocoagulation: A systematic review

Theme: Equity, diversity and inclusion
What: Equity, diversity and inclusion
Part of: EDI Symposium II: EDI in Action / de diversité, d’équité et d’inclusion II : L’EDI en action
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 716 B

Abstract

Prupose The association between demographic factors and the efficacy of anti-vascular endothelial growth factor (VEGF) therapy or panretinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR) or diabetic macular edema (DME) is not well understood. The objective of this study was to review the existing evidence on the impact of demographic factors on clinical outcomes and loss to follow-up in DR and DME following anti-VEGF and PRP therapy.

Study Design and Methods  Ovid MEDLINE, Embase, Cochrane Library, and the US National Institutes of Health clinical trials registry were searched from January 1, 2000, to July 15, 2022 for randomized controlled trials (RCTs) investigating the efficacy of anti-VEGF therapy and PRP for patients with DR and/or DME. Peer-reviewed studies stratifying outcome data by demographic factors, including age, race, sex/gender, income, and education level, were included. Outcomes of interest included loss to follow-up, visual acuity (VA), central macular thickness (CMT), and complications. Data were extracted by two independent reviewers. Risk of bias was assessed with the Cochrane Risk of Bias tool 2 and certainty of evidence was assessed with the GRADE evaluation.

Results Of 295 full texts screened, eight RCTs comprising 2441 eyes were included. One study found a strong negative association between increased age and VA gains (112 eyes) following treatment, while two others found no correlation between age and VA (144 eyes). Two articles found no differences in loss to follow-up and VA at 24 months based on groups, stratified by age, sex, and race/ethnicity. In two studies, sex was not associated with completion of follow-up at 2 years. Race was found to play a role, with White patients completing study visits more often than their Hispanic and Black counterparts, suggesting a higher trial attrition rate in non-White patients.

Conclusions Few prospective, randomized studies have explored the relationship between demographic characteristics and the effectiveness of treatment for DME and DR. Notwithstanding the fact that the demographic characteristics of study participants may not be representative of the general DME and DR patient population, we found that there are conflicting conclusions among studies. Existing studies were not designed to evaluate clinical outcomes by demographic parameters as a primary objective. Future trials on the treatment of diabetic eye disease should investigate clinical outcomes as a function of demographic features to enable more targeted care for marginalized demographic patient groups that experience poorer clinical outcomes.

Presenter(s)

Presenting Author: Jeeventh Kaur

Additional Author(s):

Tara Gholamian, University of Ottawa

Dana Taghaddos, University of Ottawa

Sabreena Moosa, University of Toronto

Marko Popovic, University of Toronto

Gareth Mercer, University of Toronto

Rajeev H Muni, University of Toronto

Peter J Kertes, University of Toronto

Radha Kohly, University of Toronto

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