Artikel
Evidence-based therapy of diabetic retinopathy
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
Text
Objective
Evidence based medicine is often misunderstood as "cookbook medicine with standard recipies" that doesn't take clinical experience into account. The invitation to this year's DOG meeting states that evidence based medicine is supposed to be a basis for decision making in caring for individual patients under consideration of patients' preferences. This seems to be very important since diabetic retinopathy continues to be the most frequent cause of vision loss in working age adults with negative consequences for patients' quality of life and for health economics.
Methods
The most important evidence based therapy for diabetic retinopathy and maculopathy is lasercoagulation. Vitrectomy for proliferative stages has also been proven effective by clinical studies. For more recent treatment options like triamcinolone injection and vitrectomy for diabetic macular edema there is a lower level of evidence so far.
Results
The Diabetic Retinopathy Study was the first to show the effeciveness of panfundus lasercoagulation for a larger group of patients. The Early Treatment Diabetic Retinopathy Study in turn serves as a basis for lasercoagulation of retinopathy and maculopathy. The Diabetic Retinopathy Vitrectomy Study could show the advantages of timely vitrectomy. Both, the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study could show the value of intensive blood glucose control.
Conclusions
Evidence based medicine on the basis of the studies mentioned above is practiced quite self-evidently in ophthalmo-diabetology. It should be regarded as a helpful tool for special therapeutic situations which still leaves room for ones personal clinical experience to be included. It is somewhat problematic that the term evidence based medicine seems to be restricted to the results of large randomized studies, because even special problems and very individual, difficult therapeutic questions can be placed on an evidence based foundation using todays modern means of literature research.