title: Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort.
abstract: OBJECTIVE
  To evaluate how the monitoring and treatment for diabetic macular edema (DME) has changed in a national sample.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  
  
  
  METHODS
  Administrative medical claims data from a large, national U.S. insurer.
  
  
  METHODS
  Beneficiaries of a U.S. insurance company.
  
  
  METHODS
  All incident cases of DME were found. Those in years 2002/3, 2006 and 2010 were followed for a 2-year observation period and those from 2009, 2010 and 2011 for a 1-year observation period.
  
  
  METHODS
  Types and frequencies of treatment were tallied and compared over each of the cohorts.
  
  
  RESULTS
  Two-year cohorts had 233, 251 and 756 patients in 2002/3, 2006 and 2010 respectively. One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (anti-VEGF) (p<0.001). The highest use of anti-VEGF agents in any of the cohorts was in the 2011 1-year group that only averaged 3.78 injections. Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of DME patients receiving anti-VEGF therapy in any of the cohorts.
  
  
  CONCLUSIONS
  Regardless of treatment modality (laser or injection) DME patients received vastly fewer treatments than patients in randomized control trials. Despite the proven superior visual outcomes of anti-VEGF agents over focal laser in DME, focal laser was still used more frequently.
authors.affiliation: Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Brian L
authors.initials: BL
authors.lastname: VanderBeek
authors.affiliation: Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Neepa
authors.initials: N
authors.lastname: Shah
authors.affiliation: Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Purak C
authors.initials: PC
authors.lastname: Parikh
authors.affiliation: Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Ma
mesh_terms: D000068258:Bevacizumab / Q000627:therapeutic use; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008269:Macular Edema / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors / Q000276:immunology
chemical_list: C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab