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Stylianos D Georgoulas, Dawn A Sim, Pearse Andrew Keane, Catherine A Egan; Comparison of the National Institute of Clinical Excellence with the Royal College of Ophthalmologists guidelines on the treatment of Diabetic Macular Oedema.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1753.
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© ARVO (1962-2015); The Authors (2016-present)
The Royal College of Ophthalmologists (RCOPHTH) and the National Institute of Clinical Excellence (NICE) in United Kingdom recently released guidelines on the use of ranibizumab in patients with diabetic macular oedema (DMO). NICE indicates the use of ranibizumab when central macular thickness (CMT) is ≥400μm and the RCOPHTH suggests it when CMT ≥ 250μm and visual acuity (VA) is 78-24 ETDRS letters. The purpose of the study is to identify how many patients who were receiving macular laser therapy would qualify for ranibizumab treatment under the current RCOPHTH and the NICE guidelines.
Patients from a single-consultant’s clinic were identified from the MEH laser database during the period August-February 2013. Patients who underwent macular laser (focal or grid) were included. Data collected: a) VA on day of macular laser. b) OCT macular thickness measurement of all 9 areas of the macula (as identified by Heidelberg Spectralis OCT and Topcon 2000 software) pre- and post- laser therapy.
103 eyes from 98 patients were included. The mean age was 66.2 years (range 42-77 years old), 46.7% were male and 53.3% female. 28/103 eyes (27.2%) met the NICE criteria for ranibizumab treatment with a mean CMT of 491 μm (range 400-678). The remaining 75 eyes (72.8%), which did not meet the NICE criteria, had a mean CMT of 299 μm (range 162-399 μm). With the RCOPHTH criteria, 27/103 (26.2%) of eyes were eligible for ranibizumab treatment. 86/103 eyes had CMT ≥ 250μm (mean CMT of 374 μm, range 250-678 μm) and 30/103 eyes had ETDRS VA between 78-24 letters. 19/103 eyes (18.4%) met both NICE and RCOPHTH criteria, and 9/103 eyes (8.7%) met NICE but not RCOPHTH criteria and 8/103 eyes (7.8 %) met RCOPHTH but not NICE criteria.
This study indicates that, although the implementation of the two different guidelines results in about the same percentage of ranibizumab treatment eligibility for DMO and there is treatment-agreement in the majority of cases, there is a potential under-treatment risk for about 9% of the sample.
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