How to Achieve Near-Normal Visual Acuity with Bevacizumab in Diabetic Macular Edema Patients

Patients suffering from diabetic retinopathy (DR) and diabetic macular edema (DME) are inherently interested in achieving normal or near-normal visual acuity. The study aimed to investigate factors influencing the visual acuity achieved by DME patients after bevacizumab (IVB) treatment. 98 patients (98 eyes) diagnosed with DR and DME underwent IVB treatment (9 injections/12 months). Patients were diagnosed and monitored using swept-source optical coherence tomography (SS-OCT), ultra-wide-field fluorescein angiography (UWFFA) and Early Treatment Diabetic Retinopathy Study (ETDRS) chart testing. We assessed macular central subfield thickness (CST), non-proliferative diabetic retinopathy (NPDR) indicators and best-corrected visual acuity (BCVA). After the treatment, patients were divided into BCVA_≤75 and BCVA_>75 groups. The IVB therapy increased the number of ETDRS letters read by about 9 and 8 in the BCVA_≤75 and the BCVA_>75 group, respectively. Before and after treatment, the BCVA_>75 group had lower CST than the BCVA_≤75 group. The treatment reduced macular CST by 177 μm in the BCVA_≤75 group and only by 93 μm in the BCVA_>75 group. Total non-perfusion area (NPA) decreased in both BCVA score groups after IVB therapy. Normal or near-normal vision can be achieved with IVB treatment, provided it starts when visual acuity is not significantly reduced yet. The ophthalmic screening of DR patients should also target those with relatively high visual acuity.