Trends in the Use of Laser and Anti-Vascular Endothelial Growth Factor Injection for Proliferative Diabetic Retinopathy in the United States

BACKGROUND AND OBJECTIVE: The DRCR Retina Network Protocol S established anti-vascular endothelial growth factor (anti-VEGF) therapy as non-inferior to panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). This study examines PDR treatment trends in the United States from 2016 to 2023. PATIENTS AND METHODS: This retrospective study used the TriNetX US Collaborative Network to identify PDR patients diagnosed between 2016 and 2023. Patients were stratified by treatment type (anti-VEGF, laser/PRP, or both) and demographic factors. Treatment rates were analyzed using prevalence ratios (PRs) with 95% confidence intervals (CIs). RESULTS: From 2016 to 2023, laser/PRP treatment rates decreased (PR 0.76, CI 0.71-0.80), while anti-VEGF (PR 1.61, CI 1.52-1.71) and combination treatment rates (PR 1.21, CI 1.12-1.32) increased. Hispanic patients had declining anti-VEGF rates during 2020 to 2023 but had higher laser rates than White patients. CONCLUSION: There is a growing preference for multimodal treatment, though single therapies remain dominant. Disparities among minority groups warrant further investigation.