Purpose: To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Methods: This was a retrospective study of patients with DME initially treated with bevacizumab and switched to ranibizumab. Visual acuity (VA) and central retinal thickness (CRT) were retrieved at fixed timepoints prior to and after the switch. Results: Forty eyes of 32 patients were included in the study. The difference in VA between any of these fixed timepoints was not statistically significant. A significant gain in VA was found in eyes that lost more than 0.1 logMAR during treatment with the last 3 bevacizumab injections. The mean CRT was significantly lower after the first 3 ranibizumab injections and at the final follow-up (p<0.001), a 67 ± 14 μm and 78 ± 18 μm reduction in thickness, respectively. Conclusions: Switching to ranibizumab resulted in a significant decrease in the CRT of eyes with DME, and should be considered when there is a lack of response or deterioration while on bevacizumab injections. A significant gain in VA was observed in a subgroup of eyes that lost more than one line while receiving the last 3 bevacizumab injections prior to the switch.

To evaluate the visual acuity results of monthly ranibizumab injections compared with a variable-dosing schedule for the treatment of neovascular age-related macular degeneration. A retrospective study that compared two cohorts of consecutive patients. All patients were treatment naive, with baseline visual acuity of 20/400 or better, and completed 12 months of therapy. In the first group all patients received monthly injections. In the other group, after 3 monthly loading doses, a variable-dosing schedule was used, based on a monthly clinical assessment and optical coherence tomography. Fifty-six consecutive patients (60 eyes) were included. At 12 months the median number of injections were 12 and 8, respectively, and the mean change in Snellen visual acuity was an improvement of 0.27 logarithm of the minimum angle of resolution in the monthly treated group versus 0.21 logarithm of the minimum angle of resolution improvement in the variable-dosing group (P = 0.53). In the monthly treated group 96.8% of eyes lost <0.3 logarithm of the minimum angle of resolution versus 96.6% of eyes in the variable-dosing group (P = 1.0). We were able to show that in our clinical setting patients achieved similar visual acuity results with either monthly injections or with a variable-dosing protocol. There was a trend toward better results with monthly treatment.

Aim: To evaluate a real-world clinical integration of an autonomous artificial intelligence (AI) system (AEYE Diagnostic Screening (AEYE-DS), AEYE Health, USA) for diabetic retinopathy (DR) screening using the Topcon NW500 camera (Topcon, Japan) in an endocrinology clinic. Methods: Adults with type 1 or type 2 diabetes without previously reported DR attending routine endocrinology follow-up were invited to participate. Non-mydriatic, macula-centred fundus photographs were acquired by a novice, non-ophthalmic operator. Images were analysed by AEYE-DS to detect more-than-mild DR (mtmDR). AI-positive results prompted physician counselling and automated referral for internal confirmatory examination. Results: Definitive AEYE-DS results were obtained for 95.7% (245/256) of participants without pharmacological dilation. Seventy-six (29.6%) patients screened positive for mtmDR, of whom 34 (44.7%) completed confirmatory examination at the institution’s retina clinic; externally completed follow-up was not captured. Four patients (11.8% of those evaluated) required treatment with intravitreal anti-vascular endothelial growth factor therapy or panretinal photocoagulation. Additional previously unrecognised ocular conditions were identified among several AI-positive patients. Patient satisfaction was high, with >80% reporting the screening was easy to use, time-efficient and recommendable. Conclusions: In a real-world endocrinology clinic, autonomous AI screening for DR using AEYE-DS integrated with the Topcon NW500 enabled efficient DR screening and achieved high non-mydriatic imageability. A clinically relevant proportion of patients requiring ophthalmic evaluation has been captured. Internal referral for confirmatory testing enabled assessment of downstream outcomes. The findings support scalable, point-of-care autonomous screening and a stepped-referral approach for AI-positive patients.