Skip to main content

Advertisement

Log in

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

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010;376:124–36.

    Article  PubMed  Google Scholar 

  2. Das A, McGuire PG, Rangasamy S. Diabetic macular edema: pathophysiology and novel therapeutic targets. Ophthalmology. 2015;122:1375–94.

    Article  PubMed  Google Scholar 

  3. Davis MD, Kern TS, Rand LI. Diabetic retinopathy. In: Alberti KGMM, Zimmet P, DeFronzo RA, editors. International textbook of diabetes mellitus. 2nd ed. Chichester: Wiley; 1997. p. 1413–46.

    Google Scholar 

  4. Miyazaki M, Kubo M, Kiyohara Y, Okubo K, Nakamura H, Fujisawa K, et al. Comparison of diagnostic methods for diabetes mellitus based on prevalence of retinopathy in a Japanese population: the Hisayama Study. Diabetologia. 2004;47:1411–5.

    Article  CAS  PubMed  Google Scholar 

  5. Kawasaki R, Wang JJ, Wong TY, Kayama T, Yamashita H. Impaired glucose tolerance, but not impaired fasting glucose, is associated with retinopathy in Japanese population: the Funagata study. Diabetes Obes Metab. 2008;10:514–5.

    Article  CAS  PubMed  Google Scholar 

  6. Wako R, Yasukawa T, Kato A, Omori T, Ishida S, Ishibashi T, et al. Causes and prevalence of visual impairment in Japan. Nippon Ganka Gakkai Zasshi. 2014;118:495–501 [in Japanese].

    PubMed  Google Scholar 

  7. Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–64.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985;103:1796–806.

    Article  Google Scholar 

  9. Diabetic Retinopathy Clinical Research Network. Diurnal variation in retinal thickening measurement by OCT in center-involved diabetic macular edema. Arch Ophthalmol. 2006;124:1701–7.

    Article  PubMed Central  Google Scholar 

  10. Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99:753–9.

    Article  CAS  PubMed  Google Scholar 

  11. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol. 1996;122:258–60.

    Article  CAS  PubMed  Google Scholar 

  12. Jonas JB, Söfker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001;132:425–7.

    Article  CAS  PubMed  Google Scholar 

  13. Cunningham ET Jr, Adamis AP, Altaweel M, Aiello LP, Bressler NM, D’Amico DJ, et al. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 2005;112:1747–57.

    Article  PubMed  Google Scholar 

  14. Ogura Y, Sakamoto T, Yoshimura N, Ishibashi T. Phase 2/3 clinical trial of WP-0508 (MaQaid® intravitreal injection) for diabetic macular edema. Atarashii Ganka. 2014;31:1876–84 [in Japanese].

    Google Scholar 

  15. Ishibashi T, Li X, Koh A, Lai TYY, Lee FL, Lee WK, et al. The REVEAL study: ranibizumab monotherapy or combined with laser versus laser monotherapy in Asian patients with diabetic macular edema. Ophthalmology. 2015;122:1402–15.

    Article  PubMed  Google Scholar 

  16. Korobelnik JF, Do DV, Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014;121:2247–54.

    Article  PubMed  Google Scholar 

  17. Nozaki M, Suzuma K, Inoue M, Kawasaki R, Kida T, Takamura Y, et al. Preference and trends of treatment for diabetic retinopathy in Korea and Japan. Nippon Ganka Gakkai Zasshi. 2013;117:735–42 [in Japanese].

    PubMed  Google Scholar 

  18. Stewart MW. Anti-VEGF therapy for diabetic macular edema. Curr Diab Rep. 2014;. doi:10.1007/s11892-014-0510-4.

    PubMed  Google Scholar 

  19. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127:688–93.

    Article  CAS  PubMed  Google Scholar 

  20. The Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372:1193–203.

    Article  PubMed Central  Google Scholar 

  21. Diabetic Retinopathy Clinical Research Network. Treatment for central-involved diabetic macular edema in eyes with very good visual acuity. Version 3.0 (April 18, 2014). http://publicfiles.jaeb.org/ Treatment_CIDME_Eyes_Good_Vision_V3.pdf. Accessed 4 Nov 2015.

  22. Sakamoto T, Hida T, Tano Y, Negi A, Takeuchi S, Ishibashi T, et al. Survey of triamcinolone acetonide for ocular diseases in Japan. Nippon Ganka Gakkai Zasshi. 2007;111:936–45 [in Japanese].

    CAS  PubMed  Google Scholar 

  23. Sakamoto T, Ishibashi T, Ogura Y, Shiraga F, Takeuchi S, Yamashita H. Survey of triamcinolone-related non-infectious endophthalmitis. Nippon Ganka Gakkai Zasshi. 2011;115:523–8 [in Japanese].

    PubMed  Google Scholar 

  24. Shimura M, Yasuda K, Minezaki T, Noma H. Reduction in the frequency of intravitreal bevacizumab administrations achieved by posterior subtenon injection of triamcinolone acetonide in patients with diffuse diabetic macular edema. Jpn J Ophthalmol. 2016;. doi:10.1007/s10384-016-0458-9 Epub 2016 Jun 15.

    PubMed  Google Scholar 

  25. Diabetic Retinopathy Clinical Research Network Writing Committee. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology. 2010;117:1087–93.

    Article  Google Scholar 

  26. Terasaki H, Kojima T, Niwa H, Piao CH, Ueno S, Kondo M, et al. Changes in focal macular electroretinograms and foveal thickness after vitrectomy for diabetic macular edema. Invest Ophthalmol Vis Sci. 2003;44:4465–72.

    Article  PubMed  Google Scholar 

  27. Ikeda T, Sato K, Katano T, Hayashi Y. Improved visual acuity following pars plana vitrectomy for diabetic cystoid macular edema and detached posterior hyaloid. Retina. 2000;20:220–2.

    Article  CAS  PubMed  Google Scholar 

  28. Simunovic MP, Hunyor AP, Ho IV. Vitrectomy for diabetic macular edema: a systematic review and meta-analysis. Can J Ophthalmol. 2014;49:188–95.

    Article  PubMed  Google Scholar 

  29. Prünte C, Fajnkuchen F, Mahmood S, Ricci F, Hatz K, Studnička J, et al. Ranibizumab 0.5 mg treat-and-extend regimen for diabetic macular oedema: the RETAIN study. Br J Ophthalmol. 2016;100(6):787–95.

    Article  PubMed  Google Scholar 

  30. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118:615–25.

    Article  PubMed  Google Scholar 

  31. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119:789–801.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

For contributing to the creation of the questionnaire used in the present survey, we express our gratitude to Makoto Inoue (Kyorin University School of Medicine, Japan), Miho Nozaki (Nagoya City University Graduate School of Medical Sciences, Japan), Tomoaki Murakami (Kyoto University Graduate School of Medicine, Japan), Shigeo Yoshida (Kyushu University Graduate School of Medical Sciences, Japan), Masahiko Shimura (Tokyo Medical University Hachioji Medical Center, Japan), Kiyoshi Suzuma (Kyoto University Graduate School of Medicine, Japan), and Yoshihiro Takamura (University of Fukui Faculty of Medical Sciences, Japan). For their contributions to the discussion regarding the present survey, we would also like to express our gratitude to Edoardo Midena (University of Padova, Italy), Susan B. Bressler (Johns Hopkins Wilmer Eye Institute, USA), and Toshinori Murata (Shinshu University Graduate School of Medicine, Japan). We would also like to thank every specialist who attended the meeting where the survey took place and responded to the questionnaire. Medical writing and editing support was provided by Havas Worldwide Japan K. K. The specialist panel meeting on DME management was funded and operated by Bayer Yakuhin, Ltd., Japan. Bayer Yakuhin, Ltd. did not influence any of the contents of this paper.

Conflict of interest

Y. Ogura, Consultant fees (Alcon, Janssen Pharma, Wakamoto), Speaker fees (Baush Lomb, Bayer, Kissei Pharma, Kowa, Novartis, Santen, Sanwa Kagaku, Senju, Topcon); F. Shiraga, None; H. Terasaki, Grants (Novartis, Pfizer, Santen, Wakamoto), Consultant fees (Bayer Health Care), Honoraria (Bayer Health Care, Novartis, Pfizer, Santen, Wakamoto), Writing fees (Santen); M. Ohji, Grants (Alcon, Bayer, Hoya, Novartis, Otuka, Pfizer, Santen, Senju), Consultant fees (Alcon, Allergan, B & L, Bayer, Hoya, Novartis, Pfizer, Santen), Lecture fees (Alcon, Bayer, Hoya, Kowa, Novartis, Otuka, Pfizer, Santen, Senju); S. Ishida, Grants (Bayer, Novartis, Santen), Honoraria (Bayer, Novartis, Santen, Senju); T. Sakamoto, Grants (Alcon, Santen), Consultant fees (Senju), Honoraria (Alcon, Bayer, Novartis, Santen, Senju, Wakamoto), Travel fees for lecture (Alcon, Bayer, Novartis, Santen, Senju, Wakamoto); A. Hirakata, None; T. Ishibashi, Consultant fees (Alcon, Bayer, Novartis, Santen, Senju, Wakamoto).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuichiro Ogura.

Electronic supplementary material

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogura, Y., Shiraga, F., Terasaki, H. et al. Clinical practice pattern in management of diabetic macular edema in Japan: survey results of Japanese retinal specialists. Jpn J Ophthalmol 61, 43–50 (2017). https://doi.org/10.1007/s10384-016-0481-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-016-0481-x

Keywords

Navigation