PUBLICATION EXCLUSIVE: Which DRCR.net protocol has had the biggest impact on your practice?

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Protocol I

If I had to pick only one study that has had the biggest impact on my current practice among the many important multicenter randomized clinical trials carried out by DRCR.net, it would be Protocol I. At the time of study, anti-VEGF agents were being used mostly for age-related macular degeneration, and focal/grid laser treatment was the standard of care for management of diabetic macular edema. In addition, small studies suggested that intravitreal steroids may be beneficial for DME.

Protocol I showed clearly that intravitreal injections of anti-VEGF with prompt or deferred laser treatment achieved superior visual acuity outcomes compared with laser alone or steroid with prompt laser. In addition, the anti-VEGF groups were followed for 5 years, giving us an opportunity to study long-term safety and efficacy outcomes. It showed that the visual acuity benefit from anti-VEGF for DME was maintained despite needing fewer intravitreal injections over time with very few ocular side effects. Thus, Protocol I has helped to establish anti-VEGF therapy as the first-line treatment for center-involved DME; as a result, I am doing less focal/grid lasers now and use intravitreal steroids as a second-line treatment in most cases. In my opinion, this study had a profound impact on how most of us are currently treating patients with DME.

Click here to read the full publication exclusive, Point/Counter, published in Ocular Surgery News U.S. Edition, March 25, 2017.