Diabetic Retinopathy Clinical Trial
Official title:
Early Laser Treatment for Diabetic Eye Disease in China: The PEARL Pilot Randomized Trial
To compare immediate laser pan-retinal photocoagulation (PRP) treatment of severe or very severe non proliferative diabetic retinopathy (NPDR) stage versus deferral of treatment until the appearance of any proliferative diabetic retinopathy (PDR) in rural and urban patients in China. Interview data from some patients and survey data from ophthalmologists in the study hospitals will help determine acceptability of early treatment, and how to overcome barriers to increased use of this option.
Status | Recruiting |
Enrollment | 200 |
Est. completion date | October 2023 |
Est. primary completion date | October 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 80 Years |
Eligibility | Inclusion Criteria: - Adults aged >= 18 years with untreated DR at severe or very severe NPDR stage in either one or both eyes, according to the clinical opinion of the investigator. - Sufficiently clear ocular media to allow visualization of the retina and retinal photography in either eye. - Capable of giving informed consent. Exclusion Criteria: - DR at later stage of retinopathy than severe or very severe (eg, two or more of the 4-2-1 criteria are met) NPDR in either eye, but a patient may be enrolled if one eye has severe or very severe NPDR and the fellow eye has PRP-treated PDR and has been stable after treatment. - Clinically significant macular edema in either eye. - Dense cataracts or other media opacity preventing visualization of the retina in the eye. - History of previous surgical or laser treatment for DR or other retinal conditions in a study eye, including history of anti-VEGF or corticosteroid injection or focal laser for DME within 6 months, or any history of scleral buckle, vitrectomy or other retinal detachment repair. - History of other retinal vascular disorders including CRVO, CRAO, BRVO, BRAO in the study eye. - Previous cataract or glaucoma surgery is specifically allowed if performed = 6 weeks prior to enrollment. - Pregnancy. - Severe renal insufficiency treated with hemodialysis treatment, kidney transplant, pancreatic transplant, and intensive insulin therapy initiated within 4 months. - Nystagmus, unable to cooperate with laser treatment. |
Country | Name | City | State |
---|---|---|---|
China | Zhongshan Ophthalmic Center | Guangzhou | Guangdong |
Lead Sponsor | Collaborator |
---|---|
Sun Yat-sen University | First Affiliated Hospital, Sun Yat-Sen University, Queen's University, Belfast |
China,
Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991 May;98(5 Suppl):823-33. — View Citation
Japanese Society of Ophthalmic Diabetology, Subcommittee on the Study of Diabetic Retinopathy Treatment, Sato Y, Kojimahara N, Kitano S, Kato S, Ando N, Yamaguchi N, Hori S. Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy. Jpn J Ophthalmol. 2012 Jan;56(1):52-9. doi: 10.1007/s10384-011-0095-2. Epub 2011 Oct 19. — View Citation
Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, Waugh N. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess. 2015 Jul;19(51):v-xxviii, 1-247. doi: 10.3310/hta19510. Review. — View Citation
Shimura M, Yasuda K, Nakazawa T, Kano T, Ohta S, Tamai M. Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 2003 Dec;110(12):2386-94. — View Citation
Wang FH, Liang YB, Zhang F, Wang JJ, Wei WB, Tao QS, Sun LP, Friedman DS, Wang NL, Wong TY. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology. 2009 Mar;116(3):461-7. doi: 10.1016/j.ophtha.2008.10.003. Epub 2009 Jan 24. — View Citation
Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G; 2010 China Noncommunicable Disease Surveillance Group. Prevalence and control of diabetes in Chinese adults. JAMA. 2013 Sep 4;310(9):948-59. doi: 10.1001/jama.2013.168118. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Comparing the Early versus Standard groups: Proportion of participants show on recommended revisits on time and accept recommended treatments (laser treatment .etc) | 1 year | ||
Other | Patient vision-related quality of life (VRQOL); composite and individual domain scores of the NEI VFQ25 questionnaire. | 1 year | ||
Primary | Proportion of eyes progressing to any degree of PDR | The diagnosis of PDR will be made by detecting either active new vessels in the optic nerve head or elsewhere in the retina as determined by fundus photography read by a masked investigator or preretinal/vitreous haemorrhage at any time during the 12 month follow-up period. | 1 year | |
Secondary | Proportion of early versus standard treated eyes with: Loss of >= 10 and of 15 ETDRS letters | 1 year | ||
Secondary | Mean change in best corrected visual acuity from baseline to week 52. | 1 year | ||
Secondary | Proportion of early versus standard treated eyes with: retinal detachment | 1 year | ||
Secondary | Proportion of early versus standard treated eyes with: increase of diabetic macular edema per Optical Coherence Tomography | 1 year | ||
Secondary | Sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists | Study ophthalmologists will also ascertain the primary outcome measure (diagnosis of any degree of PDR) on the basis of slit-lamp biomicropscopy fundus examination with a contact lens and indirect ophthalmoscopy. We will compare the sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists with the gold stander (diagnosis provided by graders according to the fundus photos.) | 1 year |
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