PURPOSE: To characterize the rates of pan-retinal laser photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) medications before and after publication of the DRCR.net Protocol S.DESIGN: A retrospective, cross-sectional study from January 1, 2012 to September 30, 2019 using a nationally representative claims-based database, Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). Subjects, Participants, and/or Controls: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF. Methods, Intervention, or Testing: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 24, 2015).MAIN OUTCOME MEASURES: Annual rates of anti-VEGF or PRP treatments per 1,000 treated eyes with PDR.RESULTS: From 2012 to 2019, 10035 PRP or anti-VEGF treatments were given to 3685 PDR eyes. 63.6% (6379) of these were anti-VEGF agents and 36.4% (3656) were PRP treatments. 88.7% of eyes treated with anti-VEGF received the same agent throughout treatment and 7.7% were treated with both PRP and anti-VEGF agents. PRP rates declined from 784/1,000 treated eyes in 2012 to 566/1,000 in 2019 (pre-Protocol S: beta = -32 vs. post-Protocol S: beta = -77, p=0.005) while anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (beta = -48 vs. beta = 161, p=0.001). PRP rates in DME eyes did not significantly change from 474/1000 in 2012 to 363/1000 in 2019 (beta = -9 vs. beta = -58, p=0.091), but anti-VEGF rates increased significantly from 1533/1000 in 2012 to 2096/1000 in 2019 (beta = -57 vs. beta = 187, p=0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (beta = -31 vs. beta = -111, p<0.001) and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (beta = -48 vs. beta = 140, p<0.001).CONCLUSIONS: Following the publication of Protocol S, PRP rates decreased while anti-VEGF rates increased largely from increases in bevacizumab use. PRP rates significantly declined among eyes without DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.
View details for DOI 10.1016/j.oret.2020.07.018
View details for PubMedID 32693033