Patient Profile: Proliferative Diabetic Retinopathy (PDR)

DIAGNOSING AND TREATING A PATIENT LIKE DOREEN

Fundoscopic appearance of Proliferative Diabetic Retinopathy.

For a patient with proliferative diabetic retinopathy (PDR), the overarching goal is to reduce disease severity. You can help drive patient outcomes through early detection, monitoring, and timely referral.^1-3 A severity scale can help identify and standardize the clinical features of diabetic retinopathy (DR) at various stages and allow for early detection and timely intervention.^1,4-6

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PDR Example

Doreen

Female

49 years of age

Right eye (OD)

PDR

Onset 5 years ago

No previous treatment

Clinical Findings

Retinal: NVD and NVE with fibrous proliferation

ETDRS-DRSS Score: 61

CRT: 275 μm

IOP: 18 mm Hg

ETDRS Letters: 69

Snellen Equivalent: 20/40

HbA1c: 11.5

BMI: 33

Medical History

Comorbidities: Type 2 diabetes (16 years), treated with metformin and dapagliflozin; stage 1 kidney disease; diabetic neuropathy treated with gabapentin; obesity

Familial: Mother had type 2 diabetes with vision loss

Note: This is a representative case example that you may encounter in clinical practice.

BMI = body mass index; CRT = central retinal thickness; ETDRS-DRSS = Early Treatment Diabetic Retinopathy Study–Diabetic Retinopathy Severity Scale; HbA1c = glycated hemoglobin; IOP = intraocular pressure; NVD = neovascularization of the disc; NVE = neovascularization elsewhere.

Insurance

Commercial

Timely Refer Appropriate Patients to a Retina Specialist Who Can Treat DR^2,3

Important Safety Information and Indications

CONTRAINDICATIONS

EYLEA is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.

WARNINGS AND PRECAUTIONS

Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.
Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.
There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.

ADVERSE REACTIONS

Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.
The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.
Patients may experience temporary visual disturbances after an intravitreal injection with EYLEA and the associated eye examinations. Advise patients not to drive or use machinery until visual function has recovered sufficiently.

INDICATIONS

EYLEA® (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).

Please see the full Prescribing Information for EYLEA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

The information provided in this site is intended for U.S. Doctors of Optometry.

References:

Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 suppl):823-833.
Care of the Patient With Diabetes Mellitus: Quick Reference Guide. American Optometric Association website. http://bit.ly/2M22OUJ. Accessed January 14, 2020.
Ferrucci S, Yeh B. Diabetic retinopathy by the numbers. Rev Optom. June 15, 2016. http://bit.ly/2KNNJ4E. Accessed January 14, 2020.
Davis MD, Fisher MR, Gangnon RE, et al; for the Early Treatment Diabetic Retinopathy Study Research Group. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study report #18. Invest Ophthalmol Vis Sci. 1998;39(2):233-252.
Staurenghi G, Feltgen N, Arnold JJ, et al. Impact of baseline Diabetic Retinopathy Severity Scale scores on visual outcomes in the VIVID-DME and VISTA-DME studies. Br J Ophthalmol. 2018;102(7):954-958.
American Academy of Ophthalmology. Preferred Practice Pattern®: Diabetic Retinopathy. http://bit.ly/2SX3H2D. Accessed January 14, 2020.

DR PATIENT PROFILES