Charles Wykoff, MD, PhD: Context of the PANORAMA Trial

The PANORAMA trial is an ongoing study of aflibercept (Eyelea) injections in patients with non-proliferative diabetic retinopathy (NPDR), but not diabetic macular edema (DME), compared to sham.

Charles Wykoff, MD, PhD, Retina Consultants of Houston, and Deputy Chair of Ophthalmology at Blanton Eye Institute, Houston Methodist Hospital presented the study’s 52-week results at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, BC.

Wykoff noted that while there are certain cases of diabetic retinopathy that clearly require treatment, there are other situations, such as with non-center involved macular edema or even center-involving DME without vision loss, that are less clear-cut.

What's the important context of the PANORAMA trial?

Yes, so the context of this is diabetic retinopathy so certainly there are certain thresholds for diabetic retinopathy that we all agree should be treated in most cases, things like high-risk proliferative diabetic retinopathy, diabetic macular edema with visual loss, there are certain thresholds that are well accepted that we treat. Then there a remarkable number of thresholds which are sort of poorly-defined, where things like non-center involved diabetic macular edema or even diabetic macular edema that's center-involving without vision loss—when do you intervene on that? There's certainly discussion to be had.

The key threshold that PANORAMA is addressing are high-risk NPDR eyes without DME. What's fascinating about this population is that they're largely well sighted eyes, many of them completely asymptomatic, but we know this population of patients with moderately severe to severe NPDR have a very real risk of progression to a vision-threatening complication such as proliferative diabetic retinopathy or center-involved DME. We know this population of patients is at high risk—we've known that since the ETDRS trial the 1980s and PANORAMA provides the first prospective, large data set looking at this population in the anti-VEGF era with treatment arms. That's sort of the context.