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

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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

All Science Journal Classification (ASJC) codes

  • 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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AU - Ogura, Yuichiro

AU - Shiraga, Fumio

AU - Terasaki, Hiroko

AU - Ohji, Masahito

AU - Ishida, Susumu

AU - Sakamoto, Taiji

AU - Hirakata, Akito

AU - Ishibashi, Tatsuro

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