Clinical practice pattern in management of diabetic macular edema in Japan: survey results of Japanese retinal specialists

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. Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. 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. 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.