Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not in adult patients with diabetic macular edema intravetrial bevacizumab injections are more effective than laser therapy at improving best-corrected visual acuity.

STUDY DESIGN: Review of three English language non-blinded randomized control trials from 2010 and 2012.

DATA SOURCES: Non-blinded randomized control trials comparing intravetrial bevacizumab injections to macular laser therapy found using Pubmed and EBSCOhost web databases. All articles were published in peer-reviewed journals.

OUTCOMES MEASURED: The primary outcome of best-corrected visual acuity (BCVA) was measured using the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol and visual acuity charts and Snellen visual acuity charts at 6, 12, and 24 months in their respective studies.

RESULTS: When comparing macular laser therapy to intravetrial bevacizumab injections the patients receiving the injections had a statistically significant (P > 0.05) increase in BCVA at 1, 12, and 24-month time points. At 24 months the proportion of patients who gained 10 or more letters was 49% for the bevacizumab group and 7% in the laser therapy group.

CONCLUSION: Although macular laser therapy is the current standard of care for diabetic macular edema (DME), it has been proven to produce inferior clinical outcomes alone when compared with intravetrial bevacizumab injections and other monoclonal antibodies. Long-term use of bevacizumab should be considered as an initial treatment modality for DME to not only halt vision loss, but restore vision as well.

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