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<p>Diabetic macular edema (DME) is a principal cause of impaired vision in individuals with diabetes. The effectiveness of treatment using intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) has been established in clinical trials, and it has become the treatment of choice for the majority of DME patients. However, real-world treatment outcomes for patients with DME have consistently lagged behind those reported in clinical trials. Nonadherence to IVI treatment and loss to follow-up (LTFU) limit the results of clinical treatment for patients with DME in real-world conditions.</p><p>Herein, we report results from different real-world studies and analyse high levels of nonadherence to anti-VEGF treatment in patients with DME. IVI adherence may involve a variety of patient-related, condition-related, therapy-related, and COVID-19-related factors. Notably, although the overall adherence rate to IVI declined during the COVID-19 pandemic, targeted interventions addressing treatment barriers significantly improved DME patient adherence. In this review, we highlight changes in IVI practices that were implemented to reduce nonadherence in patients with DME during the pandemic, along with other emerging strategies, including assessments of the risk of visual impairment and prioritisation of treatment; distinguishing among types of appointments; modifications of anti-VEGF injection protocols; diversification of medical services, telemedicine, and artificial intelligence (AI); and improvements in patient education.</p><p>Our analysis identified multifaceted factors associated with nonadherence to IVI among DME patients and proposed corresponding intervention strategies. Future investigations should focus on developing clinically feasible adherence assessment tools and standardised metrics to facilitate individualised therapeutic decision-making. We advocate for the systematic integration of adherence monitoring into standardized clinical workflows as a fundamental component of IVI management protocols. This evidence-based paradigm holds significant promise in addressing the growing practical challenges in contemporary DME management.</p>

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Nonadherence to anti-VEGF intravitreal injections in patients with diabetic macular edema

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Yang Lv,
  • Li Zhu,
  • Fu-hong Li,
  • Hong Li

摘要

Diabetic macular edema (DME) is a principal cause of impaired vision in individuals with diabetes. The effectiveness of treatment using intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) has been established in clinical trials, and it has become the treatment of choice for the majority of DME patients. However, real-world treatment outcomes for patients with DME have consistently lagged behind those reported in clinical trials. Nonadherence to IVI treatment and loss to follow-up (LTFU) limit the results of clinical treatment for patients with DME in real-world conditions.

Herein, we report results from different real-world studies and analyse high levels of nonadherence to anti-VEGF treatment in patients with DME. IVI adherence may involve a variety of patient-related, condition-related, therapy-related, and COVID-19-related factors. Notably, although the overall adherence rate to IVI declined during the COVID-19 pandemic, targeted interventions addressing treatment barriers significantly improved DME patient adherence. In this review, we highlight changes in IVI practices that were implemented to reduce nonadherence in patients with DME during the pandemic, along with other emerging strategies, including assessments of the risk of visual impairment and prioritisation of treatment; distinguishing among types of appointments; modifications of anti-VEGF injection protocols; diversification of medical services, telemedicine, and artificial intelligence (AI); and improvements in patient education.

Our analysis identified multifaceted factors associated with nonadherence to IVI among DME patients and proposed corresponding intervention strategies. Future investigations should focus on developing clinically feasible adherence assessment tools and standardised metrics to facilitate individualised therapeutic decision-making. We advocate for the systematic integration of adherence monitoring into standardized clinical workflows as a fundamental component of IVI management protocols. This evidence-based paradigm holds significant promise in addressing the growing practical challenges in contemporary DME management.