Predictors of visual acuity improvement in elderly patients with vision loss with diabetic retinopathy
DOI:
https://doi.org/10.5281/zenodo.22812340Keywords:
diabetic retinopathy, diabetic macular edema, visual acuity, elderly patients, anti-VEGF therapyAbstract
Background: Anti-VEGF and laser therapy for diabetic macular edema produce visual gains that vary widely, and elderly patients, with longer disease duration and greater comorbidity, feature prominently among the poorer responders in trial subgroups.
Objective: This review synthesizes evidence on predictors of visual acuity improvement in diabetic retinopathy and macular edema, focusing on how age and age-associated factors modify treatment response.
Methods: We conducted a narrative synthesis of major anti-VEGF and laser randomized trials, subgroup and post-hoc analyses, OCT biomarker cohorts, and epidemiologic studies across the age spectrum.
Findings: Baseline acuity and outer retinal structural integrity, particularly ellipsoid zone disruption and disorganization of retinal inner layers, predict the ceiling for recovery; early response within the first three cycles strongly predicts one-year outcome; and older age acts largely through disease duration, structural damage, comorbidity, and adherence rather than an independent biological non-response.
Conclusions: Visual acuity improvement is best predicted by baseline OCT biomarkers and early treatment response rather than by age itself, supporting individualized rather than age-based treatment decisions.
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