Temporal Trends in the Treatment of Proliferative Diabetic Retinopathy: An AAO IRIS® Registry Analysis

PURPOSE: This study examined how treatment patterns for proliferative diabetic retinopathy (PDR) have changed over time using clinical registry data from the AAO IRIS® Registry (Intelligent Research in Sight). DESIGN: A retrospective cohort analysis using the IRIS Registry database spanning 2013–2017. PARTICIPANTS: A total of 141 317 patients with newly diagnosed PDR (International Classification of Diseases [ICD], Tenth Revision, codes E08.35, E09.35, E10.35, E11.35, and E13.35 and ICD, Ninth Revision, code 362.02) were included. METHODS: Comparison analyses were conducted using Tukey and chi-square tests, and time-trend analyses were conducted using Mann-Kendall tests and Theil-Sen slopes. MAIN OUTCOME MEASURES: Patient characteristics including age, gender, and laterality; whether patients received intravitreal anti–vascular endothelial growth factor injections (IVI) only, panretinal photocoagulation (PRP) only, both IVI and PRP (IVI+PRP), or observation; intravitreal drug data; and diabetic macular edema (DME) status were compared. RESULTS: From 2013–2017, the average age of PDR diagnosis was 59.2 years, with 53.3% of patients being male. Sixty-two thousand one hundred five newly diagnosed PDR patients (43.9%) received IVI, 32 293 patients (27.1%) received PRP, 27 664 patients (19.6%) received IVI+PRP, and 13 255 patients (9.4%) underwent observation. In 2013, more PDR patients undergoing treatment received PRP only (47.5%) than IVI only (37.3%) or IVI+PRP (15.1%). From 2013 to 2017, the percentage of patients treated with PRP only decreased by 5.6% per year (P = 0.05) and the percentage of patients treated with IVI only increased by 3.9% per year (P = 0.05). By 2017, most patients received IVI only (52.9%). Patients with PDR with DME were more likely than patients without DME to receive IVI only (64.3% vs. 31.5%; P < 0.001). Among patients receiving IVI and IVI+PRP, bevacizumab (69.8%) was the most common intravitreal medication given followed by aflibercept (18.4%) then ranibizumab (11.7%). CONCLUSIONS: In this cohort analysis of the IRIS Registry, IVI surpassed PRP as the more common method of treating newly diagnosed PDR from 2013 to 2017, with bevacizumab administered in more than two thirds of IVIs.