CHICAGO — Benchmarking treatment and practice patterns among your geographic peers is one thing, but the ASRS International Affairs Committee tracks trends around the world. This year, 41 societies accepted the invitation to participate (and 1010 members of these societies responded; 670 U.S.-based ASRS members answered the same 15 clinical questions as part of the 2019 PAT Survey. International societies were classified by region: Africa/Middle East (n=147), Asia/Pacific (n=264), Central and South America (n=211), and Europe (n=274).
ASRS International Affairs Committee Chair Rishi P. Singh, MD, Cleveland Clinic Cole Eye Institute, presented some of the highlights of the 6th annual Global Trends in Retina Survey. (Of note, not all respondents answered all questions; in some cases the total responses did not equal 100%.) Here are some of the highlights:
Treatment patterns for wet AMD
Treatment-naïve neovascular age-related macular degeneration (AMD) are predominantly treated with at least 3 loading doses; in the majority of regions, once the loading doses are complete treatment moves to treat-and-extend. The notable exception to this is in the Africa/Middle East region, where clinicians prefer to move to PRN dosing. In the U.S. only, clinicians prefer to move immediately to treat-and-extend as soon as a dry or stable retina allows rather than move patients to a PRN dosing schedule.
Treatment patterns for diabetic macular edema
In both the U.S. and Africa/Middle East, clinicians consider a steroid when treating patients with diabetic macular edema (DME) if those patients have had a suboptimal response to 6 anti-vascular endothelial growth factor (VEGF) agents. The remaining regions of the world are a little less conservative, and would consider a steroid after suboptimal responses to 3 anti-VEGF injections. In both options, the preferred timing to change treatment was about 2:1 over the other option.
When clinicians were specifically asked how to manage a 30-year-old, type 1 diabetic with high-risk proliferative diabetic retinopathy (PDR), but who also has excellent vision (20/20) and no DME, respondents in Africa/Middle East, Asia/Pacific, and Europe prefer complete panretinal photocoagulation (PRP) in 2 or more sessions over combining anti-VEGF with complete PRP in 2 or more sessions. Respondents in Central and South America favored the combination treatment just slightly over PRP alone (42.7% to 40.4%, respectively), while respondents in the U.S. clearly preferred the combination treatment over PRP alone (37.7% to 29.3%, respectively).
Overall anti-VEGF use
If there is an absence of adequate response to a first-line anti-VEGF, every region overwhelmingly opts to switch to a different anti-VEGF agent. Running a distant second preference in Africa/Middle East, Central and South America, and Europe is to switch to a steroid alone. In Asia-Pacific and the U.S., respondents also opt to use a steroid in combination with anti-VEGF agents. For the purposes of this survey, “adequate response” was not defined, which may account for the varied secondary responses.