November 13, 2025
2 min read
Key takeaways:
- At 2 years, 74% of Black patients and 66.4% of white patients who received ranibizumab achieved vision of 20/40 or better.
- Black patients had better baseline visual acuity and smaller change from baseline.
At 2 years, Black and white patients who received Lucentis for the treatment of diabetic macular edema achieved similar levels of best corrected visual acuity, according to a study published in JAMA Ophthalmology.
The meta-analysis also found that Black patients had better BCVA at baseline, although their average improvement at 24 months was lower than in white patients.
“Intravitreal anti-vascular endothelial growth factor therapy has been successfully used to treat participants with DME. However, recent data suggest that vision outcomes may differ between races,” M. Ali Khan, MD, of Wills Eye Hospital, and colleagues wrote. “More definitive data on whether outcomes differ between races in response to anti-VEGF treatment for DME would help inform expected outcomes.”
Khan and colleagues conducted a meta-analysis of five randomized clinical trials of Lucentis (ranibizumab, Genentech) in DME. The participants, 181 Black and 928 white, were treated with either 0.3 mg or 0.5 mg ranibizumab. The primary outcome was the average change in BCVA at month 24, evaluated separately in white and Black participants.
Compared with white participants, Black participants had better BCVA at baseline (66.7 mean ETDRS letters vs. 62) but similar BCVA as white patients at month 24 (72.8 mean ETDRS letters vs. 72.2). Vision of 20/40 or better was achieved by 74% of Black participants and 66.4% of white participants at month 24.
White participants had a greater average BCVA change from baseline after adjustment for baseline BCVA, with an increase of 9.9 ETDRS letters vs. 7.7.
To control for differences in baseline patient data and study characteristics, Khan and colleagues also conducted a propensity score-matched analysis using data from two of the studies. In this analysis, white and Black participants had similar average 24-month changes in BCVA of 10.1 ETDRS letters and 10.6 ETDRS letters, respectively.
“After matching for age, sex, baseline HbA1c, baseline central subfield thickness, baseline BCVA, number of ranibizumab injections at month 24 and total number of visits, there was no longer a difference in vision outcomes between Black and white participants,” the researchers wrote. “However, because a relatively small number of participants were included in the propensity score analyses, these findings should be interpreted with caution and require further confirmatory investigations with a larger sample size.”
Data from the five studies were insufficient for statistically meaningful analyses on any races other than white and Black, pointing to a lack of diversity in the trials, Khan and colleagues wrote.
“As these data cannot conclusively assess the impact of race on treatment outcomes with ranibizumab alone, they provide yet another argument for increased enrollment of underrepresented racial subgroups in future clinical trials,” they wrote. “Moreover, additional information regarding social determinants of health and greater characterization of race and ethnicity beyond traditional categories will be important. These steps will better allow for comprehensive evaluation of the effects of race on treatment outcomes.”
Perspective
This analysis examined whether race influences outcomes after ranibizumab treatment for diabetic macular edema. Black participants began with better baseline acuity but gained fewer letters over 2 years compared with white participants. After adjusting for baseline factors, outcomes were essentially the same, suggesting that when access to care and treatment are even, the biologic response to anti-VEGF therapy does not differ by race.
For clinicians, this study solidifies the effectiveness of ranibizumab, but the disparities in outcomes likely stem from broader social determinants of health. The smaller gains in Black participants likely reflect systemic factors, access to early care, diabetes control and socioeconomic differences, not necessarily a difference in the medication’s effect.
The study’s biggest limitation is its lack of diversity. Only Black and white patients were analyzed, with minimal representation from Asian or Hispanic groups. As eye care providers, we need to push for trial diversity that reflects the populations we actually serve.
Alek Karthikeyan, OD, FAAO
Disclosures: Karthikeyan reports no relevant financial disclosures.
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