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Who Gets Panretinal Photocoagulation? National Patterns in Proliferative Diabetic Retinopathy Treatment
Serina S Applebaum1, Julia Fu1, Mathieu Bakhoum1
1Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
Purpose:
To identify factors associated with receiving panretinal photocoagulation (PRP) among individuals treated in the first year after proliferative diabetic retinopathy (PDR) diagnosis.
Design:
A retrospective cohort analysis from 2015 to 2022 using electronic health record data from 13 nationwide sites in the Sight Outcomes Research Collaborative (SOURCE) registry.
Participants:
Adults aged ≥18 years newly diagnosed with PDR, with ≥2 visits and treatment with PRP or anti-VEGF intravitreal injection (IVI) in the first year after diagnosis.
Methods:
We analyzed adjusted annual probability of PRP and anti-VEGF IVI treatment. We used multivariable logistic regression to determine associations of sociodemographic and clinical factors with receiving PRP.
Main Outcome Measures:
Treatment with PRP in the first year after PDR diagnosis.
Results:
Of 2442 individuals with incident PDR, 1912 (78.3%) received treatment within a year of PDR diagnosis, of which 1147 (60.0%) received PRP. From 2015 to 2022, adjusted probability of PRP decreased from 78.6% to 59.0%, while probability of receiving anti-VEGF IVIs increased from 68.2% to 85.6%. Odds of treatment with PRP were greater for younger (adjusted odds ratio [aOR], 0.86 per 5-year increase in age; P < 0.001), non-Hispanic Black (aOR, 1.44; P = 0.02), Hispanic (aOR, 1.72; P = 0.004), unemployed (aOR, 1.42; P = 0.07), and better-seeing individuals (aOR, 1.08 per 5-letter increase in visual acuity; P < 0.001), and those with a prior ≥1-year lapse in care (aOR, 1.43; P = 0.01). Prior anti-VEGF IVI (aOR, 0.44; P < 0.001) and diabetic macular edema (aOR, 0.52; P < 0.001) decreased odds of PRP.
Conclusions:
Panretinal photocoagulation treatment declined over time. Black, Hispanic, and younger individuals, and those with a prior lapse in care, were more likely to receive PRP. Diabetic macular edema and history of anti-VEGF IVI during nonproliferative stages decreased odds of PRP.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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