Study: PRP Still Used for PDR in 60% of Cases Despite Rise of Anti-VEGF

The study suggests that physicians may favor the durable, one-time nature of PRP for patients considered at higher risk for being lost to follow-up, such as younger individuals or those with previous care lapses, as well as those with limited access to insurance coverage of anti-VEGF injections. Photo: Erin Kenny, OD, and Christin DeMoss, OD. Click image to enlarge. Managing and treating proliferative diabetic retinopathy (PDR) in the United States is an evolving landscape, with panretinal photocoagulation (PRP), once a primary intervention, now taking a backseat to anti-VEGF intravitreal injections because of its greater safety profile. Still, PRP remains widely used, a new analysis finds.  The study, by researchers from Yale, was recently published in Ophthalmology Science. Individuals more likely to receive PRP within the first year of PDR diagnosis were of Black or Hispanic/Latino origin, younger age, unemployed and better seeing, as well as those with a prior lapse in care. These same populations are at higher risk for future lapses in care. This retrospective cohort study examined national treatment patterns for PDR using electronic health record data from the Sight Outcomes Research Collaborative (SOURCE) registry, analyzing 1,912 adults newly diagnosed with PDR between 2015 and 2022 who received treatment within one year of diagnosis. Among treated individuals, 60% received PRP, either alone or in combination with anti-VEGF. Between 2015 and 2022, the adjusted probability of receiving PRP decreased from 79% to 59%, while the probability of receiving anti-VEGF increased from 68% to 73%. “This trend reflects the paradigm shift initiated by the DRCR Protocol S study, published in 2015, which demonstrated noninferiority of anti-VEGF therapy compared to PRP for PDR,” the authors wrote in their paper. “We found that treatment patterns have largely stabilized in more recent years. This plateau may indicate a new equilibrium following a rapid initial adoption of anti-VEGF treatment.” Although the COVID-19 pandemic caused significant healthcare disruptions—disproportionately affecting socially disadvantaged groups—the researchers did not identify any clear impact of this period on treatment choices.Patients with a lapse in ophthalmic care before PDR diagnosis had 1.4-fold higher adjusted odds of receiving PRP after PDR diagnosis. Individuals with a prior lapse in care may be deemed more likely to miss follow-ups in the future. Similarly, the authors noted, unemployed individuals had a nonsignificant trend toward higher adjusted odds of PRP. “Unemployment is often associated with socioeconomic instability and inadequate insurance coverage, which can pose barriers to consistent healthcare access,” they wrote in their paper. “Taken together, this suggests that physicians may appropriately favor a more durable therapy like PRP for patients at higher risk of loss to follow-up.”Individuals of Black and Hispanic/Latino origin are at increased odds of PRP, likely reflecting intersecting individual and structural factors including disease severity and barriers to accessing care, the researchers noted. “Although we lacked precise documentation of disease severity, well-documented disparities in diabetic eye care show that racially and ethnically minoritized individuals are likely to be diagnosed with DR at more advanced stages and experience higher rates of vision loss and blindness from DR,” the authors explained in their paper. Economic hardship and structural inequities also disproportionately affect minority populations, limiting access to or feasibility of frequent anti-VEGF injections.Subjects with younger age and better visual acuity at PDR diagnosis also had higher adjusted odds of PRP. Younger individuals are more likely to experience lapses in care, which may be due to competing work and social demands or de-prioritization of routine care due to better overall health. Additionally, physicians may prioritize a long-lasting intervention for younger patients, who have more years of potential visual function to preserve.Better visual acuity at diagnosis is similarly associated with lapses in care. “Patients with good vision may not perceive the need for immediate or intensive treatment, especially if they are asymptomatic,” the authors explained in their paper. “Conversely, worse visual acuity at diagnosis may more likely coincide with pathology, such as center-involving DME, which is more appropriately managed anti-VEGF therapy. Long-term effectiveness and patient-related outcomes in real-world settings should be studied, the researchers advocate, with attention to social determinants of health. Reducing disparities to optimize outcomes in diabetic eye disease will require equitable access to effective PDR treatment through community-partnered approaches, tailored to individual clinical and social context, they stated in their paper.Click here for the journal source. Applebaum SS, Fu J, Bakhoum M, et al. Who gets panretinal photocoagulation? National patterns in proliferative diabetic retinopathy treatment. Ophthalmol Sci. March 26, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.