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Melissa Liu, Yulia Wolfson, Susan B. Bressler, Diana V. Do, Howard S. Ying, Neil M. Bressler; Assessment of Time-domain and Spectral-domain Ocular Coherence Tomography in the Management of Diabetic Macular Edema with Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3173.
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Standard care for diabetic macular edema (DME) involving the center of the macula with vision impairment may include intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, with injections repeated as often as every 4 weeks. Retreatment decisions are based predominantly on ocular coherence tomography (OCT) changes in edema since the last treatment. Clinical trials that proved the benefits of anti-VEGF therapy had utilized time-domain OCT (TD-OCT), but the impact of spectral-domain OCT (SD-OCT), with greater resolution, software registration of longitudinal images and production of "change" maps, and denser sampling, has not been evaluated. The purpose of this study was to evaluate the impact of TD-OCT followed by SD-OCT on treatment decision-making in the management of DME with anti-VEGF therapy. We hypothesized that SD-OCT might alter the management decisions.
Following IRB approval, a prospective study was conducted in patients previously treated for DME with an anti-VEGF agent among 4 retina specialists at the Wilmer Eye Institute. Consented subjects underwent clinical examination and TD- and SD-OCT imaging in eligible eyes. The managing retina specialist recorded whether additional anti-VEGF was recommended, the follow-up time interval, and the level of certainty, first after performing the clinical examination and reviewing a TD-OCT, and then again after reviewing a SD-OCT.
Data were collected for 129 treatment decision pairs involving 67 eyes from 46 subjects. Non-concordant decisions occurred in 9 (7.0%) treatment decision pairs. In 7 (78%) of these 9, the addition of SD-OCT changed the retina specialist's decision from not recommending to recommending retreatment. The addition of SD-OCT increased the certainty of the retina specialist in 35.7% of all treatment decision pairs.
SD-OCT may increase the certainty and change the treatment decisions of retina specialists relative to TD-OCT when managing DME. On occasion, SD-OCT led to treatment when TD-OCT did not. Further investigations are needed to determine whether there are certain factors which led to the discordant decisions and whether such changes in management lead to improved visual outcomes.
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