• Setting Priorities for Diabetic Retinopathy Clinical Research

    By Peggy Denny and selected by Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, March/April 2017

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    Le et al. sought to identify evidence gaps and set priorities for new system­atic reviews and randomized controlled trials (RCTs) for managing diabetic retinopathy (DR), including diabetic macular edema (DME). They used a 2-round Delphi survey among Diabetic Retinopathy Clinical Research Network (DRCR.net) investigators to rate the importance of research questions on the effectiveness of various interven­tions. Through this process, the authors identified 22 high-priority clinical questions.

    The authors invited 410 DRCR.net investigators to participate (of whom 7.8% completed both rounds of the Delphi process). The authors provided recommendations from the American Academy of Ophthalmology’s 2012 Preferred Practice Patterns (PPP) for Diabetic Retinopathy as 91 answer­able clinical research questions about intervention effectiveness and asked the investigators to rate each question’s im­portance from 0 (not important) to 10 (very important); further, they invited the DRCR.net investigators to suggest other questions (15 were added for a total of 106). Questions were deemed high priority if at least 75% of respon­dents assigned an importance rating of 5 or higher in Round 2.

    The authors also extracted outcome measures relevant to DR and asked respondents to identify those that “must be measured in all studies.” In addition, they mapped Cochrane reviews published up to March 2016 to the high-priority clinical research questions.

    Among the final list of 106 clinical research questions, 22 met the defini­tion of high priority: 9/22 concerned the effectiveness of anti-VEGF therapy, and 13/22 focused on frequency of follow-up and treatment effectiveness in patients with specific characteristics (e.g., DME). Outcomes that at least 75% of respondents marked as “must be measured in all studies” included visual acuity and visual loss, death of participants, and intraocular pressure. Only 1 of the prioritized questions was associated with conclusive evidence from a Cochrane systematic review.

    Despite the limited response rate from DRCR.net members, the authors identified 22 high-priority clinical questions in the management of DR, including DME, but few were asso­ciated with Cochrane reviews. They concluded that their results support the need for further systematic reviews and RCTs to address the evidence gaps.

    The original article can be found here.