Setting Priorities for Diabetic Retinopathy Clinical Research and Identifying Evidence Gaps

Jimmy T. Le, Susan Hutfless, Tianjing Li, Neil M. Bressler, James Heyward, Ava K. Bittner, Adam Glassman, Kay Dickersin

Research output: Contribution to journalArticle

Abstract

Purpose Prioritizing comparative effectiveness research may contribute to obtaining answers that clinicians perceive they need and may minimize research that could be considered wasteful. Our objective was to identify evidence gaps and set priorities for new systematic reviews and randomized controlled trials for managing diabetic retinopathy (DR), including diabetic macular edema (DME). Design Cross-sectional study. Participants Diabetic Retinopathy Clinical Research Network (DRCR.net) investigators. Methods We provided recommendations from the American Academy of Ophthalmology's 2012 Preferred Practice Patterns for Diabetic Retinopathy as 91 answerable clinical research questions about intervention effectiveness to 410 DRCR.net investigators to rate each question's importance from 0 (not important) to 10 (very important) using a 2-round Delphi survey and to suggest additional questions. We considered questions as high priority if at least 75% of respondents to both rounds assigned an importance rating of 5 or more in round 2. We also extracted outcome measures relevant to DR and asked respondents to identify those that must be measured in all studies. We mapped Cochrane reviews published up to March 2016 to high-priority clinical research questions. Main Outcome Measure Ranking of importance of each clinical question. Results Thirty-two individuals completed rounds 1 and 2 and suggested 15 questions. Among the final list of 106 clinical research questions, 22 questions met our definition of high priority: 9 of 22 concerned the effectiveness of anti-VEGF therapy, and 13 of 22 focused on how often patients should be followed up (re-examination) and treatment effectiveness in patients with specific characteristics (e.g., DME). Outcomes that 75% or more of respondents marked as “must be measured in all studies” included visual acuity and visual loss, death of participants, and intraocular pressure. Only 1 prioritized question was associated with conclusive evidence from a Cochrane systematic review. Conclusions A limited response rate among DRCR.net members identified 22 comparative effectiveness research questions as high priority for the management of DR, including DME, but few were associated with Cochrane reviews. These results support the need of systematic reviews and randomized controlled trials to address evidence gaps.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
JournalOphthalmology Retina
Volume1
Issue number2
DOIs
StatePublished - Apr 1 2017

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Diabetic Retinopathy
Macular Edema
Comparative Effectiveness Research
Research
Randomized Controlled Trials
Research Personnel
Outcome Assessment (Health Care)
Ophthalmology
Intraocular Pressure
Vascular Endothelial Growth Factor A
Visual Acuity
Cross-Sectional Studies
Surveys and Questionnaires

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Setting Priorities for Diabetic Retinopathy Clinical Research and Identifying Evidence Gaps. / Le, Jimmy T.; Hutfless, Susan; Li, Tianjing; Bressler, Neil M.; Heyward, James; Bittner, Ava K.; Glassman, Adam; Dickersin, Kay.

In: Ophthalmology Retina, Vol. 1, No. 2, 01.04.2017, p. 94-102.

Research output: Contribution to journalArticle

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abstract = "Purpose Prioritizing comparative effectiveness research may contribute to obtaining answers that clinicians perceive they need and may minimize research that could be considered wasteful. Our objective was to identify evidence gaps and set priorities for new systematic reviews and randomized controlled trials for managing diabetic retinopathy (DR), including diabetic macular edema (DME). Design Cross-sectional study. Participants Diabetic Retinopathy Clinical Research Network (DRCR.net) investigators. Methods We provided recommendations from the American Academy of Ophthalmology's 2012 Preferred Practice Patterns for Diabetic Retinopathy as 91 answerable clinical research questions about intervention effectiveness to 410 DRCR.net investigators to rate each question's importance from 0 (not important) to 10 (very important) using a 2-round Delphi survey and to suggest additional questions. We considered questions as high priority if at least 75{\%} of respondents to both rounds assigned an importance rating of 5 or more in round 2. We also extracted outcome measures relevant to DR and asked respondents to identify those that must be measured in all studies. We mapped Cochrane reviews published up to March 2016 to high-priority clinical research questions. Main Outcome Measure Ranking of importance of each clinical question. Results Thirty-two individuals completed rounds 1 and 2 and suggested 15 questions. Among the final list of 106 clinical research questions, 22 questions met our definition of high priority: 9 of 22 concerned the effectiveness of anti-VEGF therapy, and 13 of 22 focused on how often patients should be followed up (re-examination) and treatment effectiveness in patients with specific characteristics (e.g., DME). Outcomes that 75{\%} or more of respondents marked as “must be measured in all studies” included visual acuity and visual loss, death of participants, and intraocular pressure. Only 1 prioritized question was associated with conclusive evidence from a Cochrane systematic review. Conclusions A limited response rate among DRCR.net members identified 22 comparative effectiveness research questions as high priority for the management of DR, including DME, but few were associated with Cochrane reviews. These results support the need of systematic reviews and randomized controlled trials to address evidence gaps.",
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