Clinical practice pattern in management of diabetic macular edema in Japan: survey results of Japanese retinal specialists

Yuichiro Ogura, Fumio Shiraga, Hiroko Terasaki, Masahito Ohji, Susumu Ishida, Taiji Sakamoto, Akito Hirakata, Tatsuro Ishibashi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. Methods: Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. Results: Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon’s steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon’s injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal. Conclusions: Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalJapanese Journal of Ophthalmology
Volume61
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Fingerprint

Physicians' Practice Patterns
Macular Edema
Japan
Vascular Endothelial Growth Factor A
Injections
Vitrectomy
Visual Acuity
Lasers
Therapeutics
Steroids
Intravitreal Injections
Clinical Pathology
Surveys and Questionnaires
Fluorescein Angiography
Practice Management
Optical Coherence Tomography
Capillary Permeability
Traction
Laser Therapy
Maintenance

Keywords

  • Anti-VEGF agents
  • Clinical practice pattern
  • Diabetic macular edema
  • Laser photocoagulation
  • Vitrectomy

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Clinical practice pattern in management of diabetic macular edema in Japan : survey results of Japanese retinal specialists. / Ogura, Yuichiro; Shiraga, Fumio; Terasaki, Hiroko; Ohji, Masahito; Ishida, Susumu; Sakamoto, Taiji; Hirakata, Akito; Ishibashi, Tatsuro.

In: Japanese Journal of Ophthalmology, Vol. 61, No. 1, 01.01.2017, p. 43-50.

Research output: Contribution to journalArticle

Ogura, Yuichiro ; Shiraga, Fumio ; Terasaki, Hiroko ; Ohji, Masahito ; Ishida, Susumu ; Sakamoto, Taiji ; Hirakata, Akito ; Ishibashi, Tatsuro. / Clinical practice pattern in management of diabetic macular edema in Japan : survey results of Japanese retinal specialists. In: Japanese Journal of Ophthalmology. 2017 ; Vol. 61, No. 1. pp. 43-50.
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abstract = "Purpose: To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. Methods: Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. Results: Nearly, half of the specialists (45.2 {\%}) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 {\%}) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 {\%} of specialists, whereas 21.6 {\%} use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 {\%}), irrespective of visual acuity, whereas 17.5 {\%} select off-label sub-Tenon’s steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 {\%}) or when anti-VEGF agent/laser therapy is ineffective (73.2 {\%}). For persistent DME after vitrectomy, anti-VEGF agents (46.3 {\%}) or steroids (intravitreal injections, 14.6 {\%}; sub-Tenon’s injections, 36.6 {\%}) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 {\%}) or both visual acuity and central retinal thickness stabilized (24.3 {\%}). In the maintenance phase, many specialists provide injections with pro re nata (76.3 {\%}), whereas 50.0 {\%} responded that the treat-and-extend regimen is ideal. Conclusions: Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.",
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