DIAGNOSING AND TREATING A PATIENT LIKE GEORGETTE
For a patient with diabetic macular edema (DME), the overarching goal is to preserve vision. You can help drive patient outcomes through early detection, monitoring, and timely referral.1-3 DME is a complication of diabetic retinopathy (DR) that can occur at any time.4 A severity scale can help identify and standardize the clinical features of DR at various stages and allow for early detection and timely intervention.1,5-7
CI-DME and Worsening Vision, 20/32 Baseline Vision
54 years of age
Onset 18 months
No previous anti-VEGF treatment
ETDRS-DRSS: Moderately severe NPDR (level 47)
ETDRS Letters: 75
Snellen Equivalent: 20/32
CRT: 596 μm
ETDRS-DRSS: Severe NPDR (level 53)
ETDRS Letters: 70
Snellen Equivalent: 20/40
CRT: 627 μm
Comorbidities: Type 2 diabetes (6 years), hypercholesterolemia, NPDR, cataracts, cataract extraction with intraocular lens implant, posterior vitreous detachment
Familial: Mother had type 2 diabetes with vision loss
Note: This is a representative case example that you may encounter in clinical practice.
Commercial (Avastin-first policy)
Timely Refer Appropriate Patients to a Retina Specialist Who Can Treat DME2,3
Important Safety Information and Indications
- 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.
- 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.
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.