Treating sight-threatening diabetic retinopathy in Vietnam using laser or anti-VEGF injections: Patients’ perspectives

Abstract

Purpose : The aim of this study was to understand patients' knowledge and attitudes towards laser versus anti-vascular endothelial growth factor (VEGF) injections used to treat sight-threatening DR in a low-middle income country, Vietnam. The main purpose was to provide data to help the Ministry of Health make evidence-based decisions that can improve DR management in Vietnam.

Methods : This is a descriptive qualitative study. Participants provided information about four topics: their knowledge of diabetes and DR, views on their treatment, perceived barriers to treatment and suggestions on how to improve care. Semi-structured interviews were conducted with 12 patients with DR from Ho Chi Minh City and six from Hanoi, Vietnam. Data were analysed using thematic framework analysis.

Results : The average age of participants was 53.7 years (SD±11.6 years), and 7/18 (38.9%) were female. Among the 18 participants interviewed, five (27.8%) accepted laser treatment and four accepted anti-VEGF injections (22.2%), with the remainder refusing treatment. Patients reported that it is the doctors who select the most appropriate DR treatment for their patients in Vietnam, and they often explain the benefits and risks of the chosen treatment. Patients accept that treatment clinics are busy, but regardless, they would like to receive more information on treatment schedules and likely prognosis and potential visual outcomes they can hope for. Pain was reported as a side effect of laser by two patients, with one patient reporting pain after anti-VEGF injections. The main barriers to treatment were the high cost of treatment and other out-of-pocket costs (e.g. related to travel). Patients wanted to have fewer treatment and monitoring appointments and attend clinics that are nearby in order to minimise the impact on their daily life.

Conclusions : The current study has identified themes patients reported on their treatments with laser and anti-VEGF injections for DR. Reducing treatment costs, optimising treatment protocols so fewer in-person attendances are required to complete a course of treatment, and expanding the network of clinics offering treatment outside urban areas have been the lead topics for discussion. These findings are crucial to inform policy changes in Vietnam and might be generalisable to other low-resource settings.

This is a 2021 ARVO Annual Meeting abstract.