1. Vignette and Discussion Questions
Issue #65 Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis
Vignette and Discussion Questions
Created by William E Cayley, Jr
Journal Club Editor
Eau Claire Family Medicine Residency

2. Treatment for diabetic macular oedema
Carl is a retired university professor. He has had type two diabetes for 20 years, and recently has been diagnosed with diabetic macular oedema.
Carl comes in today to see you to discuss treatment for his vision. He says he has been reading about new treatments, and is wondering what the best option is for improving his vision.

3. Both of Carl's parents had laser photocoagulation for diabetic macular oedema some time ago, and Carl says he feels they had reasonable success.
Carl is always very keen to evaluate any treatment recommendations for himself, and he says he's been researching treatment options for his diagnosis.
Carl says he is intrigued by some of the things he's read about the anti-vascular endothelial growth factor treatments (anti-VEGF), but he also has some questions.

4. Anti-vascular endothelial growth factor for diabetic
While Carl is aware these newer treatment options have been promoted as superior to laser treatment, he is also concerned about the possible role of pharmaceutical company influence in the reports he has read.
He is also concerned about the possibility of long-term side effects and whether or not the newer agents have been adequately studied.
In searching for evidence to inform your discussion of treatment options with Carl, you come across a newly published Cochrane review titled:
Anti-vascular endothelial growth factor for diabetic
macular oedema: a network meta-analysis

5. Questions for discussion
How will you use the findings of this review to inform a discussion with Carl?
Specifically, how might this review be helpful to address questions of
Relative efficacy of growth factor compared with laser treatments
Relative efficacy and side effects between anti- VEGF treatments
Long-term side effects
The impact of industry sponsorship and open-label reporting on trial results

6. Further Information How to cite the Cochrane Review:
Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD DOI: / CD pub5.
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