title: Clinical practice pattern in management of diabetic macular edema in Japan: survey results of Japanese retinal specialists.
abstract: OBJECTIVE
  To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy.
  
  
  METHODS
  Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME.
  
  
  RESULTS
  Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon's injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal.
  
  
  CONCLUSIONS
  Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. ogura@med.nagoya-cu.ac.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shiraga
authors.affiliation: Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Terasaki
authors.affiliation: Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Ohji
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
authors.affiliation: Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Akito
authors.initials: A
authors.lastname: Hirakata
authors.affiliation: Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishibashi
mesh_terms: D002983:Clinical Competence; D003930:Diabetic Retinopathy / Q000150:complications / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D007564:Japan; D008269:Macular Edema / Q000209:etiology / Q000628:therapy*; D000072163:Ophthalmologists / Q000592:standards*; D013038:Specialization; D011795:Surveys and Questionnaires
keywords: Anti-VEGF agents; Clinical practice pattern; Diabetic macular edema; Laser photocoagulation; Vitrectomy