Trends in the Management of Proliferative Diabetic Retinopathy in the First Year After Diagnosis

PURPOSE: To examine trends in initial treatment modality for patients diagnosed with proliferative diabetic retinopathy (PDR). METHODS: A cross-sectional time series was performed between 2005 and 2024 using the TriNetX US Collaborative Network. Patients with new-onset PDR were identified and initial treatment modality within one year after diagnosis was recorded. The proportion of patients managed with panretinal photocoagulation (PRP) monotherapy, anti-vascular endothelial growth factor (anti-VEGF) monotherapy, or combination therapy (PRP + anti-VEGF) were compared using Cochran-Armitage tests for trend. Rates of change in treatment proportionality were compared between 2005-2014 and 2015-2024, the time period before and after the publication of the DRCR Protocol S. RESULTS: A total of 14,768 patients with newly diagnosed PDR met inclusion criteria. In 2005, PRP monotherapy accounted for 100% of initial treatment. In 2024, combination therapy was the most commonly utilized treatment modality, accounting for 42.4% of cases (overall trend, p<0.0001), followed by anti-VEGF monotherapy at 36.1% (overall trend, p<0.0001), and PRP monotherapy at 21.5% (overall trend, p<0.0001). After 2015, the annual rate of change differed significantly compared with the pre-2015 period for both monotherapies. The proportion of patients treated with PRP monotherapy showed a steeper relative annual decline (5.22% vs 3.56% per year, p=0.0338), while anti-VEGF monotherapy demonstrated a greater relative annual increase (2.03% vs 1.58% per year, p=0.0283). CONCLUSION: Management of PDR has shifted over the past two decades from PRP monotherapy toward anti-VEGF therapy, including both combination therapy and monotherapy.