Early Laser Treatment for Diabetic Eye Disease in China : A Pilot Randomized Trial

  • STATUS
    Recruiting
  • End date
    Oct 28, 2023
  • participants needed
    200
  • sponsor
    Sun Yat-sen University
Updated on 28 May 2022
retinopathy
diabetic retinopathy
photocoagulation
diabetic eye disease
proliferative diabetic retinopathy
background diabetic retinopathy
eye disorder
severe nonproliferative diabetic retinopathy

Summary

To compare immediate laser pan-retinal photocoagulation (PRP) treatment of severe or very severe non proliferative diabetic retinopathy (NPDR) stage versus deferral of treatment until the appearance of any proliferative diabetic retinopathy (PDR) in rural and urban patients in China.

Interview data from some patients and survey data from ophthalmologists in the study hospitals will help determine acceptability of early treatment, and how to overcome barriers to increased use of this option.

Description

China now has the world's largest number of diabetic persons. Population studies show that only 10% of Chinese rural-dwellers with DR receive therapy. The current standard approach to treatment of DR often requires patients to return for multiple examinations over years, before they reach trial-proven criteria for treatment. This long process is ill-suited to support good compliance with care in low-resource settings. Our recent published review suggests that earlier PRP treatment, which could reduce the burden of compliance, may be clinically effective and cost effective, but the current evidence base is insufficient to make a firm recommendation.

Details
Condition Diabetic Retinopathy
Treatment Pan-retinal photocoagulation laser treatment
Clinical Study IdentifierNCT02956759
SponsorSun Yat-sen University
Last Modified on28 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Adults aged >= 18 years with untreated DR at severe or very severe NPDR stage in either one or both eyes, according to the clinical opinion of the investigator
Sufficiently clear ocular media to allow visualization of the retina and retinal photography in either eye
Capable of giving informed consent

Exclusion Criteria

DR at later stage of retinopathy than severe or very severe (eg, two or more of the 4-2-1 criteria are met) NPDR in either eye, but a patient may be enrolled if one eye has severe or very severe NPDR and the fellow eye has PRP-treated PDR and has been stable after treatment
Clinically significant macular edema in either eye
Dense cataracts or other media opacity preventing visualization of the retina in the eye
History of previous surgical or laser treatment for DR or other retinal conditions in a study eye, including history of anti-VEGF or corticosteroid injection or focal laser for DME within 6 months, or any history of scleral buckle, vitrectomy or other retinal detachment repair
History of other retinal vascular disorders including CRVO, CRAO, BRVO, BRAO in the study eye
Previous cataract or glaucoma surgery is specifically allowed if performed ≥ 6 weeks prior to enrollment
Pregnancy
Severe renal insufficiency treated with hemodialysis treatment, kidney transplant, pancreatic transplant, and intensive insulin therapy initiated within 4 months
Nystagmus, unable to cooperate with laser treatment
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