Who Gets Panretinal Photocoagulation? National Patterns in Proliferative Diabetic Retinopathy Treatment

Area of Science:

• Ophthalmology
• Retinal Diseases
• Diabetic Retinopathy Management

Background:

• Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes.
• Panretinal photocoagulation (PRP) and anti-VEGF intravitreal injections (IVIs) are common PDR treatments.
• Understanding factors influencing treatment choice is crucial for patient care.

Purpose of the Study:

• To identify factors associated with receiving panretinal photocoagulation (PRP) within the first year of proliferative diabetic retinopathy (PDR) diagnosis.
• To analyze trends in PRP versus anti-VEGF IVI treatment over time.

Main Methods:

• Retrospective cohort analysis (2015-2022) using electronic health record data.
• Inclusion of adult patients (≥18 years) newly diagnosed with PDR requiring treatment.
• Multivariable logistic regression used to assess sociodemographic and clinical factors associated with PRP receipt.

Main Results:

• Of 2442 individuals with PDR, 1147 (60.0%) received PRP within the first year.
• PRP treatment probability decreased from 78.6% to 59.0% between 2015 and 2022.
• Younger age, non-Hispanic Black and Hispanic ethnicity, unemployment, better visual acuity, and prior lapse in care were associated with higher odds of PRP.
• Prior anti-VEGF IVI and diabetic macular edema decreased the odds of receiving PRP.

Conclusions:

• Panretinal photocoagulation treatment rates have declined, with a concurrent rise in anti-VEGF IVI use for PDR.
• Certain demographic and clinical factors, including ethnicity and prior care lapses, influence PRP treatment likelihood.
• Diabetic macular edema and prior anti-VEGF treatment reduce the probability of receiving PRP.