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Frank D Verbraak, ; Variability in treatment decisions of DME . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):180.
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© ARVO (1962-2015); The Authors (2016-present)
To establish the differences in treatment strategy of diabetic macular edema (DME) between ophthalmologists.
Ophthalmologists in the Netherlands were invited to participate in an e-learning about the treatment of DME. They were offered 20 cases of patients with DME, and were asked to decide whether, and how to treat these cases. Cases were presented with a short case description, color fundus photo, FA early-, mid- and late frame, and an OCT b-scan. Treatment choices: no treatment, advise better regulation of riskfactors (DM, bloodpressure), anti-VEGF injections, corticosteroid injection, vitrectomy, and laser. Combinations were possible. In case of laser photocoagulation treatment the treatment spots should be annotated in the color fundus photo. The participants could compare their decisions with those of an expert panel.
The first 50 responses were analysed. In 7 / 50 cases more than 5 responders decided against treatment, while the majority were in favor of treatment. Most advised to regulate riskfactors, even though the expert panel advised this in 9 cases. A decision to use anti-VEGF injections was made by less than 10 participants in 5 cases, between 10 and 30 participants in 7 cases, and by more than 30 participants in 32 cases. The expert panel decided for anti-VEGF in 10 cases. Corticosteroids and vitrectomy were chosen as option in 4 and respectively 2 cases by less than 5 participants, and not in any case by the expert panel. A choice for laser was made in less than 10 participants in 3 cases, between 10 and 30 participants in 5 cases, and by more than 30 participants in 42 cases, and was part of the treatment of the expert panel in 13 cases. Comparing the dosage and location of the applied laser spots a wide variety could be seen, with a difference in spot counts between 6 and 11 fold, and an overlap in location of 50%.
Ophthalmologists differed widely in their decisions regarding treatment of DME even when given identical information concerning DME and possible treatable lesions. When laser was part of the treatment, there was a large difference in the number and placement of planned laser spots. This variability in the treatment of DME reflects uncertainty about preferred practice in treatment of DME, and could lead to unwanted differences in patient outcome.
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