@article {1522719, title = {Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Use after Protocol S for Proliferative Diabetic Retinopathy}, journal = {Ophthalmol Retina}, volume = {5}, number = {2}, year = {2021}, month = {2021 Feb}, pages = {151-159}, abstract = {PURPOSE: To characterize the rates of panretinal photocoagulation (PRP) and anti-vascular endothelial growth factor (VEGF) medications before and after publication of the Diabetic Retinopathy Clinical Research Network protocol S. DESIGN: A retrospective, cross-sectional study from January 2012, through September 2019, using a nationally representative claims-based database, Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). PARTICIPANTS: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF agents. METHODS: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 2015). MAIN OUTCOME MEASURES: Annual rates of anti-VEGF or PRP treatments per 1000 treated eyes with PDR. RESULTS: From 2012 through 2019, 10 035 PRP or anti-VEGF treatments were administered to 3685 PDR eyes. Of these, 63.6\% (n\ = 6379) were anti-VEGF agents, and 36.4\% (n\ = 3656) were PRP treatments. Throughout treatment, 88.7\% of eyes treated with anti-VEGF received the same agent and 7.7\% were treated with both PRP and anti-VEGF agents. Panretinal photocoagulation rates declined from 784/1000 treated eyes in 2012 to 566/1000 in 2019 (pre-Protocol S: β\ = -32 vs. post-Protocol S: -77; P\ = 0.005), whereas anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (β\ = -48 vs. 161, respectively; P\ = 0.001). Panretinal photocoagulation rates in diabetic macular edema (DME) eyes did not significantly differ from 474/1000 in 2012 to 363/1000 in 2019 (β\ = -9 vs. -58 respectively; P\ = 0.091), and anti-VEGF rates increased from 1533/1000 in 2012 to 2096/1000 in 2019 (β\ = -57 vs. 187; P\ = 0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (β\ = -31 vs. -111, respectively; P \< 0.001), and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (β\ = -48 vs. 140, respectively; P \< 0.001). CONCLUSIONS: Following the publication of Protocol S, PRP rates decreased, while anti-VEGF rates increased. Panretinal photocoagulation rates did not significantly change among eyes with DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.}, issn = {2468-6530}, doi = {10.1016/j.oret.2020.07.018}, author = {Azad, Amee D and Chen, Evan M and Hinkle, John and Rayess, Nadim and Wu, David and Eliott, Dean and Mruthyunjaya, Prithvi and Parikh, Ravi} }