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Prise en charge du traitement de l’œdème maculaire diabétique en France de 2012 à 2018 – Etude nationale LANDSCAPE

This study aimed to describe the change observed in the patients journey before and after initiation of their treatments for Diabetic Macular Edema (DME) for the entire French population between 2012 and 2018.

This was a retrospective longitudinal population study using exhaustive nationwide population data from health records of the French National Health Information database (Système National des Données de Santé [SNDS]).We identified individuals treated for DME from the French population aged 18 years and older. Identification criteria were diabetes diagnosis and reimbursement of DME treatments (anti-VEGF intravitreal injection and dexamethasone implant). Exclusion criteria were high myopia or nAMD and diagnosis of other retinal diseases.We described the number, frequency and timing of ophthalmological consultations, imaging examinations and treatments.

Between 2012 and 2018, we identified 53,584 treated DME patients, who were followed for up to 7 years from DME treatment initiation. Prior to initiation of DME treatment, the percentage of patients who had optical coherence tomography (OCT) imaging increased from 73% in 2012 to 83% in 2018; conversely, the percentage of patients undergoing fluorescein angiography decreased from 41% in 2012 to 31% in 2018. Only 14% of patients had a consultation with their diabetologist or endocrinologist in the 3 months prior to initiation of DME treatment. The percentage of patients who consulted an ophthalmologist declined linearly in the years following DME treatment initiation, with 71% still followed by an ophthalmologist 5 years after DME treatment initiation. The median annual number of consultations also decreased over the 7-years study period, from 9 visits in year 1, 5 visits in Year 2 and 4 visits per year from year 3 to year 7. The median DME treatment duration with anti-VEGF and/or dexamethasone implant treatment was 9.4 months and 54% of patients had a treatment duration less than one year. For patients continuing to be treated by anti-VEGF, the median number of anti-VEGF injections was 5 the first year and 4 per year throughout the 7-year study period. For patients continuing to be treated by dexamethasone implant, the median number of implants was 2 per year throughout the 7-year study period. First-line treatment was more commonly with ranibizumab (55% of patients) than with aflibercept (30%) followed by dexamethasone implant (15%). About 25% of patients who initiated anti-VEGF treatment with ranibizumab or aflibercept switched treatment at least once, while 30% of patients who initiated dexamethasone implant switched to anti-VEGF treatment at least once.

LANDSCAPE provides exhaustive nationwide data on real-world management of DME in France over a 7-year period. French DME patients seem well monitored by their ophthalmologist, with 71% still followed by an ophthalmologist 5 years after DME treatment initiation. OCT became the routine imaging to diagnose DME, while angiography was still used in 31% of cases of DME evaluation in 2018. Over the 2012-2018 period, median treatment duration with anti-VEGF was of 9.4 months with almost half of patients stopping their treatment within the first year.

These results emphasize the challenge to manage and treat patients with DME over the long term.