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National Institute for Health Research

Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

Overview of attention for article published in Health technology assessment : HTA / NHS R & D HTA Programme., July 2015
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (90th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (60th percentile)

Mentioned by

blogs
1 blog
policy
2 policy sources
twitter
6 X users
facebook
1 Facebook page

Citations

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64 Dimensions

Readers on

mendeley
195 Mendeley
Title
Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation
Published in
Health technology assessment : HTA / NHS R & D HTA Programme., July 2015
DOI 10.3310/hta19510
Pubmed ID
Authors

Pamela Royle, Hema Mistry, Peter Auguste, Deepson Shyangdan, Karoline Freeman, Noemi Lois, Norman Waugh

Abstract

Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR). The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP? Randomised controlled trials (RCTs) for efficacy but other designs also used. MEDLINE and EMBASE to February 2014, Web of Science. Systematic review and economic modelling. The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO. The current evidence is insufficient to recommend PRP for severe NPDR. There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs. This study is registered as PROSPERO CRD42013005408. The National Institute for Health Research Health Technology Assessment programme.

X Demographics

X Demographics

The data shown below were collected from the profiles of 6 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 195 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Mexico 1 <1%
Portugal 1 <1%
Brazil 1 <1%
Unknown 192 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 31 16%
Researcher 18 9%
Student > Bachelor 17 9%
Other 16 8%
Student > Postgraduate 11 6%
Other 38 19%
Unknown 64 33%
Readers by discipline Count As %
Medicine and Dentistry 66 34%
Nursing and Health Professions 11 6%
Agricultural and Biological Sciences 8 4%
Biochemistry, Genetics and Molecular Biology 8 4%
Pharmacology, Toxicology and Pharmaceutical Science 5 3%
Other 26 13%
Unknown 71 36%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 17. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 April 2019.
All research outputs
#2,216,068
of 26,128,906 outputs
Outputs from Health technology assessment : HTA / NHS R & D HTA Programme.
#226
of 1,250 outputs
Outputs of similar age
#26,620
of 279,068 outputs
Outputs of similar age from Health technology assessment : HTA / NHS R & D HTA Programme.
#12
of 30 outputs
Altmetric has tracked 26,128,906 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 91st percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,250 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 12.8. This one has done well, scoring higher than 81% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 279,068 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 90% of its contemporaries.
We're also able to compare this research output to 30 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 60% of its contemporaries.