Management of diabetic macular edema patients in clinical practice in Spain

Abstract

Purpose: Diabetic macular edema is the main cause of blindness in diabetic patients. Vascular endothelial growth factor is involved in diabetic macular edema pathogenesis. Vascular endothelial growth factor inhibitors are an important option in diabetic macular edema therapy. This survey investigates actual clinical practice in diabetic macular edema in Spain. Methods: An expert advisory panel of 17 Spanish ophthalmologists developed a 30-item anonymous questionnaire about diagnosis, treatment, and follow-up in diabetic macular edema. A total of 137 ophthalmologists from 10 Spanish regions completed the questionnaire online. Results: Almost all of the respondents (99.3%) record the measured visual acuity and perform biomicroscopic anterior (94.9%) and posterior (91.2%) segment examinations. Similarly, 100% of responding ophthalmologists always/almost always or frequently perform optical coherence tomography. Most respondents (65%) always/almost always or frequently perform a retinography. More than 50% rarely perform fluorescein angiography. Nearly, all (96.4%) of the specialists responded that, in center-involved diabetic macular edema, the first treatment is an anti–vascular endothelial growth factor drug. For corticosteroids, the first choice of most respondents (91.2%) was the dexamethasone implant. In the follow-up, almost all (96.4%) specialists record the measured visual acuity and most also perform biomicroscopic anterior (82.5%) and posterior (83.2%) segment examination. Conclusion: This survey shows the actual clinical practice in diabetic macular edema in Spain, finding that anti–vascular endothelial growth factor therapy is frequently used, and that diagnosis, treatments, and follow-up examinations used by specialists are homogeneous and according to diabetic macular edema guidelines.

Results of dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema patients: Early versus late switch

“…7 The results of a survey, which analyzed the current trends of diagnosis, treatment, and follow-up of DME in Spain, showed that the 96.4% who responded to the survey considered anti-VEGF as the first treatment. 8 However, despite the good functional and anatomical outcomes obtained with the anti-VEGF therapies, many patients do not adequately respond. [9][10][11][12] According to the results of the Diabetic Retinopathy Clinical Research Network (DRCR.net) study, approximately 40% of eyes receiving ranibizumab had persistent DME at 2 years.…”

Cost-consequence analysis of extended loading dose of anti-VEGF treatment in diabetic macular edema patients

“…Intravitreal treatment with corticosteroids (dexamethasone, fluocinolone acetonide) and anti-vascular endothelial growth factor (anti-VEGF) is now the first-line therapy for DME involving the central macula [4][5][6]. In current clinical practice in Spain, most specialists (96.4%) choose an anti-VEGF agent such as aflibercept, ranibizumab or bevacizumab (off label) as first-line therapy [7].…”

Comments on “Management of diabetic macular edema patients in clinical practice in Spain”

“…While in the Diabetic Retinopathy Clinical Research Network (DRCR.net) study by Wells et al 5 The patient outcomes did not differ for ranibizumab and aflibercept at 2 years, patient outcome was better at 1 year for aflibercept for those with worse visual acuity at the start of treatment. Indeed, as the authors mentioned 69.4% of doctors in a Japanese survey used aflibercept as first-line treatment, 1 it would have been interesting to know whether the specialists in the survey used visual acuity at the start of treatment as stratifying factor to choose between ranibizumab and aflibercept. 3.…”

“…Dear Editor, I read with interest the article by Abreu-Gonzalez et al 1 titled "Management of diabetic macular edema patients in clinical practice in Spain. "…”