A 62-year-old woman with type 2 diabetes has best-corrected visual acuity of 6/24 in the right eye. OCT reveals central subfield thickness of 380 microns with intraretinal cystic spaces. Fundus exam shows moderate non-proliferative diabetic retinopathy with hard exudates approaching the fovea. According to Protocol T of the DRCR.net, which anti-VEGF agent demonstrated the best visual acuity outcome at 2 years in eyes with baseline visual acuity 6/12 or worse?
- A Ranibizumab
- B Aflibercept ✓
- C Bevacizumab
- D All three agents were equivalent regardless of baseline vision
Correct answer: B. Aflibercept
Explanation
Protocol T demonstrated that aflibercept, ranibizumab, and bevacizumab were equivalent for diabetic macular edema (DME) when baseline VA was 20/40 or better. However, for eyes with baseline VA of 20/50 or worse (approximately 6/15 or worse), aflibercept provided significantly better visual acuity outcomes at 2 years. The effect was most pronounced in the first year but persisted.
Reference: Ryan's Retina, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.