The Diabetic Retinopathy Clinical Research Network What is the Role of Laser In Treating Diabetic Macular Edema in the Era of Anti-VEGF Therapy?
Financial Disclosures • None
12-7-11 After 3 Anti-VEGF injections
2-29-12 After 6 Anti-VEGF injections
What should be done next? • Is Laser the next step? • Does it help?
ETDRS Data*:Change in VA from Baseline *Of eyes with CI-DME at baseline
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.
DRCR.net Protocol I Data(Ranibizumab+prompt laser & Ranibizumab+deferred laser groups)
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
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
Mean Change in CSF Thickeningat Follow-up Visits N = 334 (52 weeks) N = 305 (104 weeks) N = 259 (156 weeks)
Change in Retinal Thickening at 3 Years* *Visits occurring between 980 and 1204 days from randomization were included as 3 year visits
Focal/Grid Laser Prior to 3 Years* * Only eyes that completed 3-year visit
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