CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments
Fire up that Laser! Treat non-compliant DR patients straight away
by Brooke Herron
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iabetic retinopathy (DR) has been a hot topic during American Society of Retina Specialists (ASRS 2021) Scientific Meeting — and with good reason. So, it was fitting to have a Hot Topics in Diabetic Retinopathy panel discussion following one of the main DR symposiums. During this brief session, Dr. Charles Wykoff presented panelists with patient cases and asked for their opinions on diagnosis management and treatment. And while we always look forward to a good debate, these experts were mostly in agreement — and it’s always interesting to learn how each ophthalmologist approaches confounding retinal cases. Below, we cover just one of the fascinating discussions presented by the panel — but it’s an important one: patient compliance.
Understanding your DR patients We all know the difficulties
poor patient compliance can present to outcomes. This is especially crucial in diabetic patients who often have additional health issues to contend with. Thus, Dr. Wykoff asked the following: Do you ever treat patients differently based on their past show rate to your clinic? Do you change treatment patterns? Or when they’re treatmentnaive, do you ever try to get a feeling for their compliance? How do you incorporate this risk into your management strategy?
Treating non-compliant patients right away is crucial First up was Dr. Sophie Bakri, who shared that it’s important to speak with the patient to get a sense of whether they might return to the clinic. “When I get the sense that somebody is not going
to come back, or they’re not compliant, or if there are any other issues going on (health or social), I do my best to do injections and PRP (panretinal photocoagulation) on the same day before they leave the office,” she shared. “I think we just have to make it happen, because the thought of that person leaving the office and then thinking ‘will the injection or laser hurt, etc.,’ and then they may never come back… I think whatever we can do to make it happen is important for these patients.”
“When I get the sense that somebody is not going to come back, or they’re not compliant, or if there are any other issues going on (health or social), I do my best to do injections and PRP (panretinal photocoagulation) on the same day before they leave the office.” — Dr. Sophie Bakri Dr. Rishi Singh was next to chime in and shared that they had just published some data on delayed PRP. He said the Academy recommends that these patients are lasered within one month of conversion to proliferative disease. “You can see major detriments in their visual acuity if you go beyond that month,” said Dr. Singh. “At month two and beyond, their level of achieving 20/25 or better vision is very, very poor. So, I think Sophie’s aggressive nature is actually very good in these patients — you’re preventing severe visual loss or impending — albeit you have to do it within a very short period of time, 3 to 4 weeks maximum,” he added. As Dr. Wykoff said in conclusion: “Fire up that laser”. Indeed, we have to agree — even though this writer isn’t an ophthalmologist herself. Getting these patients treated to prevent disease progression and save vision is crucial. As they say, “an ounce of prevention is worth a pound of cure”.
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