Practice patterns of Canadian vitreoretinal specialists in diabetic macular edema treatment

Abstract

Objective: To establish the practice patterns of Canadian vitreoretinal (VR) specialists in the treatment of diabetic macular edema (DME).

Design: A survey was mailed, faxed, e-mailed, and published online for access by all Canadian VR specialists.

Participants: All VR specialists identified from the Canadian Ophthalmology Society directory and the Canadian Retina and Vitreous Society directory.

Methods: A 19-item survey investigating treatment of DME was mailed to all VR specialists. A reminder fax and e-mail was sent with the survey attached. In all correspondence, physicians were given information regarding an available online version of the survey. The survey data was descriptively analyzed with the Statistical Package for the Social Sciences.

Results: With clinically significant macular edema (CSME) that is either away from the foveal avascular zone (FAZ) or diffuse, the most common first-line treatment option was macular photocoagulation 48 (78.8%) and 33 (54.1%), respectively. For microaneurysms within the FAZ, 33 (54.1%) of respondents chose intravitreal antivascular endothelial growth factor agents as their first-line treatment. In all, 51 respondents (83.6%) felt that vitrectomy played a role in the management of treatment-resistant CSME. Before utilizing intravitreal triamcinolone acetonide (IVT) injections, 34 (55.7%) of respondents did use a topical steroid trial to look for raised intraocular pressure whereas 16 (26.2%) of respondents did not use IVT injections at all.

Conclusions: This survey provides valuable practical information on how DME is currently being treated in Canada and may serve as a baseline to assess how these patterns evolve over time.