Who Gets Panretinal Photocoagulation? National Patterns in Proliferative Diabetic Retinopathy Treatment.

Purpose: To identify factors associated with receiving panretinal photocoagulation (PRP) among individuals treated in the first year after proliferative diabetic retinopathy (PDR) diagnosis. Design: A retrospective cohort analysis from 2015 to 2022 using electronic health record data from 13 nationwide sites in the Sight Outcomes Research Collaborative (SOURCE) registry. Participants: Adults aged ≥18 years newly diagnosed with PDR, with ≥2 visits and treatment with PRP or anti-VEGF intravitreal injection (IVI) in the first year after diagnosis. Methods: We analyzed adjusted annual probability of PRP and anti-VEGF IVI treatment. We used multivariable logistic regression to determine associations of sociodemographic and clinical factors with receiving PRP. Main Outcome Measures: Treatment with PRP in the first year after PDR diagnosis. Results: Of 2442 individuals with incident PDR, 1912 (78.3%) received treatment within a year of PDR diagnosis, of which 1147 (60.0%) received PRP. From 2015 to 2022, adjusted probability of PRP decreased from 78.6% to 59.0%, while probability of receiving anti-VEGF IVIs increased from 68.2% to 85.6%. Odds of treatment with PRP were greater for younger (adjusted odds ratio [aOR], 0.86 per 5-year increase in age; Conclusions: Panretinal photocoagulation treatment declined over time. Black, Hispanic, and younger individuals, and those with a prior lapse in care, were more likely to receive PRP. Diabetic macular edema and history of anti-VEGF IVI during nonproliferative stages decreased odds of PRP. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.