Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Patient-Centered Outcomes From a Randomized Clinical Trial

PURPOSE: To compare patient-centered outcomes in patients with proliferative diabetic retinopathy (PDR) treated with ranibizumab vs panretinal photocoagulation (PRP). DESIGN: Randomized clinical trial. METHODS: SETTING: Multicenter (55 U.S. sites). PATIENT POPULATION: Total of 216 adults with 1 study eye out of 305 adults (excluding participants with 2 study eyes, because each eye received a different treatment) with PDR, visual acuity 20/320 or better, no history of PRP. INTERVENTION: Ranibizumab (0.5 mg/0.05 mL) vs PRP. MAIN OUTCOME MEASURES: Change from baseline to 2 years in composite and prespecified subscale scores from the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), University of Alabama Low Luminance Questionnaire (UAB-LLQ), and Work Productivity and Activity Impairment Questionnaire (WPAIQ). RESULTS: For the NEI VFQ-25 and UAB-LLQ composite scores, ranibizumab PRP treatment group differences (95% CI) were +4.0 (-0.2, +8.3, P = .06) and + 1.8 (-3.5, + 7.1, P = 0.51) at 1 year, and + 2.9 (-1.5, +7.2, P = .20) and +2.3 (-2.9, +7.5, P = .37) at 2 years, respectively. Work productivity loss measured with the WPAIQ was 15.6% less with ranibizumab (-26.3%, -4.8%, P = .005) at 1 year and 2.9% (-12.2%, +6.4%, P = .54) at 2 years. Eightythree ranibizumab participants (97%) were 20/40 or better in at least 1 eye (visual acuity requirement to qualify for an unrestricted driver's license in many states) at 2 years compared with 82 PRP participants (87%, adjusted risk ratio = 1.1, 95% CI: 1.0, 1.2; P =.005). CONCLUSIONS: Though differences in some work productivity and driving-related outcomes favored ranibizumab over PRP, no differences between treatment regitinens for PDR were identified for most of the other patient-centered outcomes considered. (C) 2016 Elsevier Inc. All rights reserved.)