The Importance of Detecting Diabetic Retinopathy (DR) Early

In a Large Retrospective Analysis, Just 2 Years After Diagnosis of DR¹:

Patients with proliferative DR (PDR) were 4× more likely to have sustained blindness vs patients with mild DR¹

Patients with severe NPDR were 3.6× more likely to have sustained blindness vs patients with mild NPDR¹

AAO Iris® (Intelligent Research in Sight) registry records from January 1, 2013, through December 31, 2017; N=53,535 patients newly diagnosed with DR (n=678 evaluated for risk of sustained blindness). Risk of sustained blindness increased with development of glaucoma, AMD, RVO, diabetic macular edema (DME), vitreous hemorrhage, or retinal detachment. Sustained blindness defined as ≥2 visual acuity readings of 20/200 or worse in ≥3 months apart; no improvement beyond 20/100 after first 20/200 reading.

DR Can Become More Severe Quickly¹

Even in the course of a year, patients’ eyes can progress from one stage of DR to the next.²

Why Is Early Detection So Critical?

Find Out More

In a Clinical Study, Approximately a Third of Patients With Severe NPDR Progressed to
PDR/Anterior Segment Neovascularization (ASNV) or Developed Central-Involved DME
(CI-DME) Within 1 Year Without Treatment (prespecified subgroup analysis)²

In one study, 29.4% of severe Non-Prolifiterive Diabetic Retinopathy and 17.2% of moderately severe NPDR patients progressed to PDR/ASNV, while 32.4% of severe NPDR and 23.2% of moderately severe NPDR patients progressed to CI-DME within 1 year

Severe NPDRPDR/ASNV	29.4% (n=10/34)	Within 1 year
Moderately Severe NPDRPDR/ASNV	17.2% (n=17/99)
Severe NPDRCI-DME	32.4% (n=11/34)
Moderately Severe NPDRCI-DME	23.2% (n=23/99)

Take Action^3,4

If you see or suspect DR and DME:

EDUCATE your patients about living with DR and DME and potential treatment options^3,4

Your early and frequent discussions about progression of disease, treatment, and timely referral will help empower patients^3,4
Talk to your patients about modifiable risk factors (e.g., diet, weight, and tobacco use) for the development and progression of DR and DME⁵

REFER appropriate DR and DME patients for timely intervention^3,4

According to the AOA, patients should be referred with
- Severe NPDR within 2 to 4 weeks
- PDR within 1 week

FOLLOW UP to ensure patients have visited a retina specialist^3,4

MONITOR your patients with DR^3,4

The AOA recommends frequent monitoring of patients³
- At least every 6 to 8 months in patients with moderate NPDR and more frequently for patients with greater disease severity³

According to the AOA, DR patients should be referred to a retina specialist in a timely manner

When Patients Should Be Seen by a Retina Specialist³

High-risk PDR (with or without macular edema)	Within 24 to 48 hours
PDR	Within 2 to 4 weeks
DME/CSME	Within 2 to 4 weeks
Severe NPDR	Within 2 to 4 weeks

AAO = American Academy of Ophthalmology;
AMD = age-related macular degeneration;
CSME = clinically significant macular edema;
RVO = retinal vein occlusion.

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.

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:

Wykoff C et al. Baseline factors influencing time to blindness in patients with diabetic retinopathy: an AAO IRIS® Registry Analysis. Presented at: American Academy of Ophthalmology Annual Meeting; October 27-30, 2018; Chicago, IL.
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.
Appold K. Subscriber exclusive: tips on managing diabetic patients—developing provider relationships, educating the patient and tracking clinical signs are key. Optom Manag. May 2019. http://bit.ly/2KQPBYZ. Accessed January 14, 2020.

Early Detection

With Diabetic Retinopathy (DR), progression can occur quickly1

In a Large Retrospective Analysis, Just 2 Years After Diagnosis of DR1:

DR Can Become More Severe Quickly1

In a Clinical Study, Approximately a Third of Patients With Severe NPDR Progressed to PDR/Anterior Segment Neovascularization (ASNV) or Developed Central-Involved DME (CI-DME) Within 1 Year Without Treatment (prespecified subgroup analysis)2

Take Action3,4