Back to Journals » Clinical Ophthalmology » Volume 12

Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review

Authors Sheu SJ, Cheng CK, Kuo HK, Tsai CY, Lin TC, Tan J, Chandwani H, Adena M, Chen SJ

Received 4 April 2018

Accepted for publication 2 July 2018

Published 29 October 2018 Volume 2018:12 Pages 2189—2198


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7

1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 5Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Ophthalmology, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; 7Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; 8Global Health Economics and Outcomes Research, Allergan Singapore Pte. Ltd., Singapore, Singapore; 9Datalytics Pty Ltd, Kingston, ACT, Australia

Objectives: To characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes.
Methods: Retrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).
Results: Between 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P<0.0001, cross-cohort comparison). Among anti-VEGF-naïve patients, 69% received one to four anti-VEGF injections in the first year post-index. Overall, visual acuity improvement from baseline was minimal at 1 year (0.4 letters, observed data; 0.1 letters, last observation carried forward), and modest central macular thickness reduction (28 µm [last observation carried forward]) was detected.
Conclusion: In Taiwanese clinics, DME treatment patterns have shifted from use of laser to anti-VEGFs (with higher health care resource utilization); however, few patients receive anti-VEGF injections at the frequency reported in landmark trials, consistent with poorer visual outcomes. Effective alternative treatments with lower treatment burden should be considered.

Keywords: macular edema, diabetes, treatment patterns, treatment outcome, anti-vascular endothelial growth factor, corticosteroid

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]