title: Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Patient-Centered Outcomes From a Randomized Clinical Trial.
abstract: OBJECTIVE
  To compare patient-centered outcomes in patients with proliferative diabetic retinopathy (PDR) treated with ranibizumab vs panretinal photocoagulation (PRP).
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Setting: Multicenter (55 U.S. sites).
  
  
  METHODS
  Total of 216 adults with 1 study eye out of 305 adults (excluding participants with 2 study eyes, because each eye received a different treatment) with PDR, visual acuity 20/320 or better, no history of PRP.
  
  
  METHODS
  Ranibizumab (0.5 mg/0.05 mL) vs PRP.
  
  
  METHODS
  Change from baseline to 2 years in composite and prespecified subscale scores from the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), University of Alabama Low Luminance Questionnaire (UAB-LLQ), and Work Productivity and Activity Impairment Questionnaire (WPAIQ).
  
  
  RESULTS
  For the NEI VFQ-25 and UAB-LLQ composite scores, ranibizumab-PRP treatment group differences (95% CI) were +4.0 (-0.2, +8.3, P = .06) and +1.8 (-3.5, +7.1, P = 0.51) at 1 year, and +2.9 (-1.5, +7.2, P = .20) and +2.3 (-2.9, +7.5, P = .37) at 2 years, respectively. Work productivity loss measured with the WPAIQ was 15.6% less with ranibizumab (-26.3%, -4.8%, P = .005) at 1 year and 2.9% (-12.2%, +6.4%, P = .54) at 2 years. Eighty-three ranibizumab participants (97%) were 20/40 or better in at least 1 eye (visual acuity requirement to qualify for an unrestricted driver's license in many states) at 2 years compared with 82 PRP participants (87%, adjusted risk ratio = 1.1, 95% CI: 1.0, 1.2, P = .005).
  
  
  CONCLUSIONS
  Though differences in some work productivity and driving-related outcomes favored ranibizumab over PRP, no differences between treatment regimens for PDR were identified for most of the other patient-centered outcomes considered.
authors: Jaeb Center for Health Research, Tampa, Florida. Electronic address: drcrstat8@jaeb.org.
authors: Wesley T
authors: WT
authors: Beaulieu
authors: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Neil M
authors: NM
authors: Bressler
authors: Jaeb Center for Health Research, Tampa, Florida.
authors: Michele
authors: M
authors: Melia
authors: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Cynthia
authors: C
authors: Owsley
authors: Retinal Consultants of San Antonio, San Antonio, Texas.
authors: Calvin E
authors: CE
authors: Mein
authors: Carolina Retina Center PA, Columbia, South Carolina.
authors: Jeffrey G
authors: JG
authors: Gross
authors: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Lee M
authors: LM
authors: Jampol
authors: Jaeb Center for Health Research, Tampa, Florida.
authors: Adam R
authors: AR
authors: Glassman
mesh_terms: D000203:Activities of Daily Living; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001334:Automobile Driving; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D000069579:Ranibizumab / Q000627:therapeutic use*; D015861:Retinal Neovascularization / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D000066477:Work Performance
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab