Objective:

To explore the impact of anti-VEGF therapy on refractive error in patients with diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD), highlighting the importance of refractive error management for optimizing visual outcomes.

Key Findings:

• Patients experienced a statistically significant but small hyperopic shift (~0.10 D in study eyes and ~0.15 D in fellow eyes) over 2 years, which may not significantly impact visual acuity.
• Refractive shifts >0.50 D are typically required to impact visual acuity, indicating that the observed shifts are unlikely to be visually significant.
• Pseudophakic patients with edema showed a larger refractive shift (0.18 D) compared to those without edema, suggesting a need for careful monitoring.
• 11.4% of study eyes had refractive shifts >1.0 D at year 1, increasing to 16% at year 2, indicating variability in refractive changes.

Interpretation:

Despite small refractive shifts during anti-VEGF therapy, updating refractions may be beneficial for optimizing visual acuity in patients with DME and nAMD, emphasizing the need for clinical awareness.

Limitations:

• The study excluded patients with visual acuity worse than 20/100, which may limit generalizability and the applicability of findings to a broader patient population.
• Database limitations prevented matching for baseline lens status in the nAMD study, potentially affecting the analysis of refractive shifts.

Conclusion:

Providers should consider offering updated refractions to patients undergoing anti-VEGF treatment, even with persistent macular edema, to maximize visual outcomes and address refractive errors promptly.