Auburn Research Day 2021

Lauren Mason, MBA; Benjamin Roberts, MD University of Alabama-Birmingham, Department of Ophthalmology; Retina Consultants of Alabama; Tenwek Missions Hospital, Bomet, Kenya Cl i n i ca l Resea rch | Med i ca l St udent Treatment Outcomes and Following Compliance Rates of Kenyan Patients with Diabetic Macular Edema 006

Purpose: To assess the long-term visual outcomes and compliance rates of patients in rural Kenya with diabetic macular edema (DME) following treatment with focal grid laser and bevacizumab intravitreal injections. Methods: One hundred and fifty patient records were reviewed at Tenwek Mission Hospital in Bomet, Kenya having received laser treatment for DME from 2011 to 2016. Only 42/150 patients (55 eyes) returned for a minimum two month follow up care and were entered into the study. Of those 55 eyes, 31 eyes received bevacizumab intravitreal injections in conjunction with the focal laser treatment. Results: In the laser only group, mean pre op BVCA was 20/200, and mean post op BVCA was 20/80. In the laser only group, 12/55 (22%) patients received a second laser. In the combined laser and injection group, mean visual acuity went from pre-op 20/140 to post- op 20/200 over the course of treatment. In the combined laser and bevacizumab group, 20/31 (65%) eyes remained stable or improved over the course of treatment, and 11/31 (35%) eyes had worse vision. In the laser only group, 19/24 (79%) eyes had stable or improved vision over the course of treatment, and 5/24 (21%) eyes had worse vision. Final BVCA was > 20/40 in 7/31 (23%) eyes in the combined laser and injection group, and 15/31 (48%) eyes in the laser only group. Of the 150 patients diagnosed with DME over a period of five years, 67% of patients (100/150) did not return for follow-up care.

Figure 1. Diabetic Macular Edema

Figure 2. Diabetic Macular Edema

Conclusion: The results of our study demonstrate the efficacy of focal laser treatment for populations in rural East Africa suffering from diabetic eye disease.1 We found that mean visual acuity improved in the population of patients who were treated with focal laser only, from 20/200 to 20/80. In the combined laser and injection group, overall mean visual acuity changed from 20/140 to 20/200 over the course of treatment, showing no statistically significant change. The poor compliance with follow-up demonstrates that patients in rural areas, such as East Africa, may not benefit from injection therapy. This evidence of improvement of visual acuity in the majority of patients in the laser only group bolsters the fact that laser is efficacious, laser is long lasting, and that laser is the better choice instead of short acting bevacizumab injections for this population of patients. The results of our study show that 67% of patients (100/150) did not return for follow-up care. Poor compliance rates seen in the literature and in this study verify that focal grid laser treatment upon presentation should be the treatment of choice in this area of the world where healthcare is sparse, many cannot afford treatment, and follow-up visits are poor. In the case of an area such as Kenya, a treatment plan can be modified to control a patient’s DME with a limited number of office visits, the most effective solution that matches this particular population’s socioeconomic status. **Previously accepted and presented as a poster presentation at the American Academy of Ophthalmology annual meeting

Table 1

Focal Laser Group (n=24)

Focal Laser + Bevacizumab Injections Group (n=31)

Mean pre-op VA 20/200

20/140 20/200

Mean post-op VA (one week)

20/80

Final VA ≥ 20/40 15/31 (48%) Final VA ≤ 20/200 5/24 (21%)

7/31 (23%)

11/31 (35%) 11.6 months (range 2-34)

Median follow-up time (months)

11.2 months (range 2-44)

10