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The Diabetic Retinopathy Clinical Research Network

The Diabetic Retinopathy Clinical Research Network

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The Diabetic Retinopathy Clinical Research Network

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  1. The Diabetic Retinopathy Clinical Research Network What is the Role of Laser In Treating Diabetic Macular Edema in the Era of Anti-VEGF Therapy?

  2. Financial Disclosures • None

  3. 7-6-11

  4. 12-7-11 After 3 Anti-VEGF injections

  5. 2-29-12 After 6 Anti-VEGF injections

  6. What should be done next? • Is Laser the next step? • Does it help?

  7. Response to Laserin the ETDRS

  8. ETDRS Data*:Change in VA from Baseline *Of eyes with CI-DME at baseline

  9. Anti-VEGF therapy is now the gold standard for treating diabetic macular edema in eyes with impaired vision. Focal laser is now used for eyes not responding well to Anti-VEGF or eyes where Anti-VEGF is contraindicated. Some doctors use it as the primary treatment in eyes with very focal disease such as a circinate ring.

  10. DRCR.net Protocol I Data(Ranibizumab+prompt laser & Ranibizumab+deferred laser groups)

  11. Visual Acuity

  12. Mean Change in Visual Acuity*at Follow-up Visits N = 338 (52 weeks) N = 317 (104 weeks) N = 291 (156 weeks) *Truncated to ± 30 letters

  13. Change in Visual Acuity* *Visits occurring between 980 and 1204 days from randomization were included as 3 year visits **truncated to ± 30 letters, based on longitudinal analyses adjusting for baseline VA

  14. Retinal Thickening

  15. Mean Change in CSF Thickeningat Follow-up Visits N = 334 (52 weeks) N = 305 (104 weeks) N = 259 (156 weeks)

  16. Change in Retinal Thickening at 3 Years* *Visits occurring between 980 and 1204 days from randomization were included as 3 year visits

  17. Focal/Grid Laser Prior to 3 Years* * Only eyes that completed 3-year visit

  18. DRCR.net New Protocol

  19. Study Objectives • To compare the efficacy and safety of • Anti-VEGF with no laser • Anti-VEGF with deferred laser in eyes with DME. Efficacy will be assessed by change in visual acuity at 1 year. The study will be 2 years in duration. Protocol T Treatment Algorithm 21