Diabetic Retinopathy
Conditions
Keywords
diabetic retinopathy, Pan-retinal photocoagulation, proliferative, non-proliferative
Brief summary
To compare immediate laser pan-retinal photocoagulation (PRP) treatment of severe or very severe non proliferative diabetic retinopathy (NPDR) stage versus deferral of treatment until the appearance of any proliferative diabetic retinopathy (PDR) in rural and urban patients in China. Interview data from some patients and survey data from ophthalmologists in the study hospitals will help determine acceptability of early treatment, and how to overcome barriers to increased use of this option.
Detailed description
China now has the world's largest number of diabetic persons. Population studies show that only 10% of Chinese rural-dwellers with DR receive therapy. The current standard approach to treatment of DR often requires patients to return for multiple examinations over years, before they reach trial-proven criteria for treatment. This long process is ill-suited to support good compliance with care in low-resource settings. Our recent published review suggests that earlier PRP treatment, which could reduce the burden of compliance, may be clinically effective and cost effective, but the current evidence base is insufficient to make a firm recommendation.
Interventions
PROCEDUREPan-retinal photocoagulation laser treatment
PRP initially consists of 1200 - 1600 burns given over 2-3 sessions and separated by2-3weeks by 532-argon laser machine.
Sponsors
First Affiliated Hospital, Sun Yat-Sen University
Queen's University, Belfast
Sun Yat-sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged \>= 18 years with untreated DR at severe or very severe NPDR stage in either one or both eyes, according to the clinical opinion of the investigator. * Sufficiently clear ocular media to allow visualization of the retina and retinal photography in either eye. * Capable of giving informed consent.
Exclusion criteria
* DR at later stage of retinopathy than severe or very severe (eg, two or more of the 4-2-1 criteria are met) NPDR in either eye, but a patient may be enrolled if one eye has severe or very severe NPDR and the fellow eye has PRP-treated PDR and has been stable after treatment. * Clinically significant macular edema in either eye. * Dense cataracts or other media opacity preventing visualization of the retina in the eye. * History of previous surgical or laser treatment for DR or other retinal conditions in a study eye, including history of anti-VEGF or corticosteroid injection or focal laser for DME within 6 months, or any history of scleral buckle, vitrectomy or other retinal detachment repair. * History of other retinal vascular disorders including CRVO, CRAO, BRVO, BRAO in the study eye. * Previous cataract or glaucoma surgery is specifically allowed if performed ≥ 6 weeks prior to enrollment. * Pregnancy. * Severe renal insufficiency treated with hemodialysis treatment, kidney transplant, pancreatic transplant, and intensive insulin therapy initiated within 4 months. * Nystagmus, unable to cooperate with laser treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of eyes progressing to any degree of PDR | 1 year | The diagnosis of PDR will be made by detecting either active new vessels in the optic nerve head or elsewhere in the retina as determined by fundus photography read by a masked investigator or preretinal/vitreous haemorrhage at any time during the 12 month follow-up period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of early versus standard treated eyes with: Loss of >= 10 and of 15 ETDRS letters | 1 year | — |
| Mean change in best corrected visual acuity from baseline to week 52. | 1 year | — |
| Proportion of early versus standard treated eyes with: retinal detachment | 1 year | — |
| Proportion of early versus standard treated eyes with: increase of diabetic macular edema per Optical Coherence Tomography | 1 year | — |
| Sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists | 1 year | Study ophthalmologists will also ascertain the primary outcome measure (diagnosis of any degree of PDR) on the basis of slit-lamp biomicropscopy fundus examination with a contact lens and indirect ophthalmoscopy. We will compare the sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists with the gold stander (diagnosis provided by graders according to the fundus photos.) |
Other
| Measure | Time frame |
|---|---|
| Comparing the Early versus Standard groups: Proportion of participants show on recommended revisits on time and accept recommended treatments (laser treatment .etc) | 1 year |
| Patient vision-related quality of life (VRQOL); composite and individual domain scores of the NEI VFQ25 questionnaire. | 1 year |
Countries
China
Contacts
Primary ContactWenhui Zhu, MD
Outcome results
None listed