UPFRONT

Providing Guidance

Peter K. Kaiser, MD

Since the early diabetic retinopathy studies, our profession has been one that has always relied on excellent clinical research to guide our treatment decisions.

The landmark results from the Diabetic Retinopathy Study, followed by the Early Treatment Diabetic Retinopathy Study, cemented the use of laser photocoagulation.

But times are changing, and the number of possible treatments for diabetic macular edema is growing exponentially— focal laser, grid laser, navigated laser, micropulse laser, peripheral laser, several anti-VEGF drugs, steroid injections, steroid implants, and different types of surgery.

So how do we choose what to use? In what order should we employ these therapies? Thankfully, we have some guidance.

Funded in 2002, the Diabetic Retinopathy Clinical Research Network (DRCRnet) is a group of 120 retinal practices and more than 300 retinal specialists that is trying to provide guidance for these key clinical questions.

What many don’t realize is the sheer number of studies being performed in the network. The current study is up to letter “V.” That is an unbelievable number of protocols in a very short period of time, making the network one of the most successful NIH programs of recent memory.

In fact, the NIH is using it as a model for investigations in other diseases, such as the NeuroNext network, which is examining treatments for multiple sclerosis. In the upcoming months, several important protocol results are slated for presentation, the largest being the comparison of anti-VEGF agents for DME (Protocol T). The last patient visit is scheduled for the fall of 2014, so we will hopefully learn the results shortly thereafter.

In contrast to DME, we have at the other end of the spectrum rare retinal diseases, with which the only way to make conclusions is to meta-analyze case series. No network will ever be formed to study these diseases.

In this issue, we have articles looking at both approaches — an update on DRCRnet protocols (page 23) and a case study of MEWDS (page 58).