Clinical Scorecard: OCT Biomarkers Predict Anti-VEGF Failure in DME

At a Glance

Key Highlights

• 76% of patients required a switch from anti-VEGF therapy to dexamethasone implants (DEX-i).
• Presence of specific OCT biomarkers significantly predicts treatment failure.
• Early identification of poor responders can justify earlier switch to steroids.
• Higher central retinal thickness (CRT) and worse baseline BCVA correlate with need for treatment switch.
• Multivariate logistic regression identified significant predictors of switching therapies.

Guideline-Based Recommendations

Diagnosis

• Assess central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at baseline.

Management

• Consider switching to dexamethasone implants (DEX-i) for patients with poor response to anti-VEGF.

Monitoring & Follow-up

• Monitor OCT biomarkers such as subretinal fluid (SRF), hyperreflective foci (HRF), and vitreo-macular interface (VMI) abnormalities.

Risks

• Increased risk of treatment failure with the presence of specific OCT biomarkers.

Patient & Prescribing Data

Patients with diabetic macular edema (DME) showing suboptimal response to anti-VEGF therapy.

Switching to DEX-i may improve outcomes in patients with high CRT and specific OCT findings.

Clinical Best Practices

• Utilize OCT biomarkers for early identification of nonresponders to anti-VEGF therapy.
• Implement a protocol for timely switching to steroid therapy in identified poor responders.

References

• British Journal of Ophthalmology Study