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Anti-VEGF retreatment yields modest gains in DME patients returning with stable vision

Kelsey Moroz

Key Takeaways

  1. Patients with DME who returned after being lost to follow-up with stable vision were less likely to achieve visual or anatomical improvement after restarting anti-VEGF therapy than those who returned with vision decline.
  2. Patients who returned with visual acuity of 20/50 or better did not experience vision gains after retreatment despite showing anatomical improvements.

Patients with diabetic macular edema (DME) who maintained stable vision despite being lost to follow-up experienced suboptimal responses after restarting anti-VEGF therapy, according to a study.

Researchers evaluated patients with center-involved DME (n = 976) who had been lost to follow-up for at least 6 months and later resumed anti-VEGF treatment. After a median absence of 259 days, 447 patients (45.8%) returned with stabilized visual acuity, while 529 (54.2%) returned with vision decline.

Following anti-VEGF reinitiation, 32.7% of patients with stabilized vision achieved visual gains, compared with 62.0% of those who returned with reduced vision. Anatomical improvement, defined as at least a 10% reduction in central foveal thickness, was also less frequent among patients with stabilized vision (56.4% vs 63.2%).

Patients returning with stabilized visual acuity had lower odds of visual improvement and a trend toward lower odds of anatomical improvement compared with those who returned with vision loss. However, greater numbers of anti-VEGF injections during retreatment were associated with increased likelihood of both visual and anatomical benefits.

The authors also noted that patients who returned with stabilized visual acuity, of 20/50 or better did not experience visual gains after retreatment despite demonstrating anatomical improvement.

Reference
Zhou C, Shen Y, Li S, et al. Therapeutic response to anti-VEGF retreatment among eyes with stabilized vision after being lost to follow-up in diabetic macular edema: A nationwide, registry-based cohort study. Am J Ophthalmol. 2026;S0002-9394(26)00341-7. doi: 10.1016/j.ajo.2026.06.035. Epub ahead of print. PMID: 42331128.

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