Choosing the right treatment for proliferative diabetic retinopathy
Arguments for laser and anti-VEGF therapy factor in efficacy, safety, cost, and pragmatic issues
Take-home: Retina specialists who are Diabetic Retinopathy Clinical Research Network investigators offer views on whether laser panretinal photocoagulation or anti-VEGF therapy deserves consideration as first-line treatment for proliferative diabetic retinopathy.
With the introduction of anti-VEGF therapy, clinicians have argued whether pharmacotherapy or laser panretinal photocoagulation (PRP) deserves consideration as the first-line treatment for proliferative diabetic retinopathy (PDR).
Since the results of the Diabetic Retinopathy Study were reported in 1981, PRP has been the gold standard treatment for PDR. Then, in 2015, anti-VEGF therapy with intravitreal ranibizumab (Lucentis, Genentech) emerged as a new option, based on findings from Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol S.
In that prospective, randomized study, the primary outcome analysis of mean change in visual acuity (VA) from baseline showed ranibizumab 0.5 mg was non-inferior to PRP at 2 years. Statistically, significant differences favoring ranibizumab were found in analyses of VA area under the curve over the course of the study, visual field sensitivity loss, vitrectomy rate, and incidence of diabetic macular edema (DME).
Debating the roles of PRP and anti-VEGF therapy for PDR, Judy E. Kim, MD, professor of ophthalmology, Medical College of Wisconsin, Milwaukee, named the level 1 evidence from Protocol S as one of five reasons why retina specialists should consider choosing pharmacotherapy.
Speaking as the proponent for PRP, David J. Browning, MD, PhD, a retina specialist in private practice, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC, acknowledged that according to Protocol S, intravitreal ranibizumab is the winner as far as efficacy and safety are concerned.
He pointed out that it is an excellent choice for a patient whose medical insurance covers the cost. Looking at the issue with a global view and from an economic perspective, however, PRP is the obvious choice for managing the world’s PDR case burden.