Impact of baseline visual acuity, time-in-range and early treatment on functional outcomes in DMO: insights from the IRISS outcomes
Year: 2025
Type: article
Abstract: BACKGROUND/OBJECTIVES: The initial visual acuity (VA) prior to treatment initiation can significantly influence long-term visual outcomes. The current analysis aimed to examine change in VA by baseline vision categories and their effects on time spent within visual change categories in patients with diabetic macular oedema (DMO) who underwent treatment with the intravitreal fluocinolone acetonide (FAc) implant. SUBJECTS/METHODS: This was a post-hoc analysis of the IRISS-Registry Data. Time-in-range (TIR) was calculated based on three VA letter-score-thresholds: ≥70, ≥65, and ≥60 ETDRS letters after treatment initiation. TIR was stratified by baseline VA in three groups: 0-33, 34-68, and 69-100 letters. The primary outcome was the mean TIR for the ≥70 letters threshold (equivalent to 6/12 in Snellen). RESULTS: A total of 671 eyes from 542 patients were included. VA improved significantly in all VA swimlane groups, with 84.8%, 71.7%, and 60.0% of eyes in the 0-33, 34-68, and 69-100 baseline VA categories, respectively, showing maintained or improved VA at 36 months (p = 0.0367). The mean TIR for the ≥70 letter threshold was significantly longer in the 69-100 letters subgroup (892.7 ± 413.4 days) compared to the 34-68 (648.4 ± 366.4 days) and 0-33 (251.3 ± 175.9 days) subgroups (p < 0.0001). No significant differences in TIR were observed based on the duration of DMO or the number of previous anti-angiogenic injections. CONCLUSIONS: Eyes with better initial VA maintained functionally better visual acuity for longer following FAc implant treatment. TIR emerged as a potentially clinically relevant endpoint for evaluating long-term treatment outcomes in DMO, offering a broader perspective than traditional VA measures.
Source: Eye
Authors: Igor Kozak, Ramin Khoramnia, Simon R. Taylor, Usha Chakravarthy, on behalf of the ILUVIEN Registry Safety Study (IRISS) Investigators Group, Robin Hamilton, Usha Chakravarthy, Guzaliya Safiullina, Geeta Menon, Ramesh Sivaraj, Haralabos Eleftheriadis, Simon R. Taylor, Saad Younis, Konstantinos Balaskas, Vasant Raman, Fahd Quhill, Bushra Mushtaq, Nicholas Glover, Ben Burton, David Steel, Salim Natha, Somnath Banerjee, Deepthi Seneviratne, Nishal Patel, Spyridon Mourtzoukos, Riaz Asaria, Ajay Bhatnagar, Rehna Khan, Ahmed Kamal, Clare Bailey, Louise Downey, Anil Kumar, Gonçalo Almeida, Patrick Richardson, Hadi Zambarakji, Colin Jones, Katrin Lorenz, Karl U. Bartz-Schmidt, Frank Holz, Lars Wagenfeld, Peter Wiedemann, Rainer Guthoff, Manfred Tetz, Gerd U. Auffarth, Christian Ksinsik, Frank Koch, Helmut Sachs, Dirk Sandner, Berthold Seitz, João Figueira, Ângela Carneiro, José Henriques, Rufino Silva, Miguel Amaro, Angelina Meireles, João Paulo Castro Sousa, António Rodrigues, Rui Carvalho
Institutions: University of Arizona, University Hospital Heidelberg, Augenklinik Heidelberg, University Hospital Carl Gustav Carus, Technische Universität Dresden, University of Surrey, Queen's University Belfast, NIHR Moorfields Biomedical Research Centre, Frimley Park Hospital, Heart of England NHS Foundation Trust, Kings Health Partners, Royal Surrey County Hospital, Imperial College London, Manchester Royal Eye Hospital, Derriford Hospital, Royal Hallamshire Hospital, Sandwell & West Birmingham Hospitals NHS Trust, Queen Elizabeth Hospital Birmingham, James Paget University Hospital, Sunderland Royal Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, University Hospitals of Leicester NHS Trust, Leighton Hospital, Kent and Canterbury Hospital, Queen Alexandra Hospital, The Royal Free Hospital, New Cross Hospital, Calderdale and Huddersfield NHS Foundation Trust, Aintree University Hospital, Bristol Eye Hospital, Hull University Teaching Hospitals NHS Trust, Queen's Hospital, Maidstone Hospital, Royal Derby Hospital, Whipps Cross University Hospital, Norfolk and Norwich University Hospital, Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Universitätsklinikum Tübingen, University of Bonn, University Medical Center Hamburg-Eppendorf, University Hospital Leipzig, Heinrich Heine University Düsseldorf, Heidelberg University, Therapiezentrum Burgau, Klinikum Passau, University Hospital Frankfurt, Krankenhaus Dresden-Friedrichstadt, Klinik und Poliklinik für Augenheilkunde am Universitätsklinikum Carl Gustav Carus, Universitätsklinikum des Saarlandes, Association for Innovation and Biomedical Research on Light and Image, Hospital de São João, Unidade Local de Saúde de Coimbra, Hospital Vila Franca de Xira, Hospital de Santo António, Centro Hospitalar Leiria EPE, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,590
OpenAlex ID: W4416937868