DIAGNOSING AND TREATING A PATIENT LIKE KEVIN
For a patient with nonproliferative diabetic retinopathy (NPDR), the overarching goal is to reduce disease severity and reduce progression to proliferative DR (PDR). 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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Moderately Severe NPDR Example
Kevin
Male
58 years of age
Right eye (OD), Left eye (OS)
Moderately severe NPDR, bilateral OD/OS
Onset 5 years ago
No previous treatment
Clinical Findings
Retinal:
- OD—Microaneurysms, small intraretinal hemorrhages in 4 fields, venous beading definite in 1 field; intraretinal microvascular abnormalities definite in 1 field
- OS (not pictured)—Microaneurysms, small intraretinal hemorrhages in 4 fields, venous beading in 1 field, intraretinal microvascular abnormalities definite in 1 field, diffuse hard and soft exudates
ETDRS-DRSS Score: 47, bilateral
CRT: OS—247 μm, OD—253 μm
IOP: OS—15 mm Hg, OD—16 mm Hg
ETDRS Letters: OD—81, OS—80
Snellen Equivalent: 20/25, bilateral
HbA1c: 9.3
BMI: 31
Medical History
Comorbidities: Type 2 diabetes (13 years), treated with insulin; diabetic neuropathy treated with pregabalin; obesity
Familial: None known
Note: This is a representative case example that you may encounter in clinical practice.
Insurance
Commercial, no restrictions
Timely Refer Appropriate Patients to a Retina Specialist Who Can Treat DR2,3
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.
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.
