Contrast Sensitivity Changes in Center Involving Diabetic Macular Edema Treated with Aflibercept

Abstract

Donald R Nixon,1 Nicholas Flinn,2 Claudia Enderlein3 1Department of Surgery Northern Ontario School of Medicine Nosm, Sudbury, Ontario, P3E 2C6, Canada; 2Trimed Eye Centre Barrie Ontario, Barrie, Ontario, L4M 4S5, Canada; 3Trillium Health Partners, Mississauga, Ontario, L5B 1B8, CanadaCorrespondence: Donald R Nixon Email [email protected]: To characterize the changes in contrast sensitivity (CS) and retinal anatomy in patients with center involving diabetic macular edema (CDME) measured from baseline to post-loading doses of aflibercept.Patients and Methods: This single center, prospective, open-label, non-controlled evaluation of five aflibercept intravitreal injections for treatment of CDME over a 16-week period. One eye in each of the forty patients will receive aflibercept every 4 weeks. Subject testing includes measurements of central retinal thickness (CRT), best corrected visual acuity (BCVA), Pelli–Robson (PR) CS, and CamBlobs (CB) CS at 20 weeks post baseline.Results: A total of 40 eyes from 40 patients with CDME were analyzed. The mean age was 62.9 ± 10.6 years and 55% were male. At baseline, CRT was 365 ± 94.6μm with logMAR BCVA 0.25± 0.20. CS PR at baseline was 1.46± 0.13 logCS compared to the normal population 1.79± 0.10 logCS (P=< 0.01), and the CS CB was 1.55± 0.16 logCS compared to 1.92± 0.08 logCS in the normal population (P=< 0.01). At the completion of the study, CRT was decreased to 289 ± 43.7μm (P=< 0.001), and the logMAR BCVA improved to 0.18± 0.02 (P=< 0.05). At the same point the CS PR was 1.52± 0.16 and CS CB was 1.62± 0.16 logCS. At the end of the study 85% of eyes obtained BCVA of 0.3 logMAR or better. There was a reduction from baseline of 82.5% to 57.5% in the number of patients that had a CS that was two standard deviations below the mean. The greatest improvement in CS was associated with those patients that had the greatest reduction in CRT.Conclusion: CS impairment in patients with CDME is significant. Although treatment can be associated with improvement, there still remains a group with decreased CS that could impact activities of daily living. Earlier intervention using reduction in CS as a metric may be associated with reduced residual deficit associated with treatment.Keywords: contrast sensitivity, residual deficit, functional impairment

Keywords

• contrast sensitivity
• residual deficit
• functional impairment