Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity

Catharina Busch*, Mali Okada, Dinah Zur, Samantha Fraser-Bell, Patricio J. Rodríguez-Valdés, Zafer Cebeci, Marco Lupidi, Adrian T. Fung, Pierre Henry Gabrielle, Ermete Giancipoli, Voraporn Chaikitmongkol, Inês Laíns, Ana Rita Santos, Paradee Kunavisarut, Anna Sala-Puigdollers, Jay Chhablani, Malgorzata Ozimek, Assaf Hilely, Valentin Degenhardt, Anat LoewensteinMatias Iglicki, Matus Rehak, the International Retina Group

*Corresponding author for this work

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Purpose: To investigate clinical baseline characteristics and optical coherence tomography biomarkers predicting visual loss during observation in eyes with diabetic macular oedema (DMO) and good baseline visual acuity (VA). Methods: A sub-analysis of a 12-month, retrospective study, including patients with baseline VA ≤0.1 logMAR (≥20/25 Snellen) and centre-involving DMO. The primary outcome measure was the correlation between baseline characteristics and VA loss ≥10 letters during follow-up. Results: A total of 249 eyes were included in the initial study, of which 147 eyes were observed and 80 eyes received anti-vascular endothelial growth factor (VEGF) treatment at baseline. Visual acuity (VA) loss ≥10 letters occurred in 21.8% (observed cohort) and in 24.3% (treated cohort), respectively. Within observed eyes, presence of hyperreflective foci [HRF; odds ratio (OR): 3.18, p = 0.046], and disorganization of inner retina layers (DRIL; OR: 2.71, p = 0.026) were associated with a higher risk of VA loss ≥10 letters. In observed eyes with a combined presence of HRF, DRIL and ellipsoid zone (EZ) disruption, the risk of VA loss was further increased (OR: 3.86, p = 0.034). In eyes with combined presence of DRIL, HRF and EZ disruption, risk of VA loss was 46.7% (7/15 eyes) in the observed cohort, and 26.3% (5/19 eyes) in the treated cohort (p = 0.26). Conclusion: Patients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti-VEGF in these patients may potentially decrease the risk of VA loss at 12 months.

Original languageEnglish
Pages (from-to)e801-e806
Number of pages6
JournalActa Ophthalmologica
Issue number7
Publication statusPublished - 1 Nov 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • diabetes
  • diabetic macular oedema
  • diabetic retinopathy
  • good visual acuity
  • intravitreal therapy
  • macular oedema
  • observation


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