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