SAT-599 Options in managing diabetic eye disease. Laser therapy to aid improved compliance and decrease the burden of care.

Abstract Disclosure: V.A. Preda: None. C. Wijeweera: None. J. Jabbour: None. Background: Diabetic eye disease can be a devastating complication of diabetes and there is a greater burden of disease in disadvantaged groups. Intravitreal anti-VEGF injections (IVI) are the mainstay of most vision saving in patients with diabetic macular oedema (DMO) which affects around 4-8% of diabetics. Poor compliance, however, has been reported amongst rural and remote populations due to various factors such as financial constraints, geographic isolation, occupational commitments, and procedural anxieties. Subthreshold micropulse laser (SML) is a non-scarring form of macular laser that may be used as monotherapy or in combination with intravitreal anti-VEGF injections. Macular laser may reduce the number of anti-VEGF injections. SML may serve as a useful adjunct to anti-VEGF injections, particularly in rural and remote settings where a reduction in the number of anti-VEGF injections could significantly improve compliance and preserve vision. Methods: A search of six databases was conducted. A meta-analysis of mean differences was performed including subgroup analyses. Primary outcome was the number of IVI (anti-VEGF injections) at 12 - 14 months. The secondary outcomes were the change in central macular thickness (CMT) and best corrected visual acuity (BCVA) at 6-8 months, and 12-14 months. Results: To date we have included a total of 13 papers including 8 randomised clinical trials and 5 retrospective clinical studies are included in our study, capturing 625 eyes of 555 patients. In pooling data, we found a significant reduction in the number of IVI at 12-14 months in patients with poor visual acuity at baseline (6/18 Snellen or worse) with combination therapy (IVI + SML); mean difference -2.25 (95% CI; -3.35,-1.15; p<0.05). Our analysis also showed significant improvements to both BCVA and CMT at the 95% confidence intervals at 12-14 months -0.94 (-1.67, -0.20) and -1.92 (-3.52, -0.32) respectively with combination therapy (IVI + SML). Conclusion: Our findings demonstrate a significant reduction in IVI burden as well as improved BCVA and a reduction in CMT in the combination group (IVI + SML) compared to IVI monotherapy group. Combination therapy may improve patient compliance due to the reduced frequency of ocular injections. In addition, subthreshhold micropulse laser would be a useful and cost-effective addition to the management of DMO, with emerging data. This is particularly important for greater equity of care, including disadvantaged patients in rural and remote areas who also have the tyranny of distance to access diabetic complication care. Presentation: Saturday, July 12, 2025