Evidence based medicine in Ophthalmo-Diabetology
Steffen Hörle (Marburg)
Introduction: Evidence based medicine (EBM) is often misunderstood as „cookbook medicine
with standard recipies“ that doesn’t take clinical experience into account. It is, however,
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.
Materials and 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 (DRS) was the first to show the effectiveness of panfundus
lasercoagulation for a larger group of patients. The Early Treatment Diabetic Retinopathy Study (ETDRS) in turn
serves as a basis for lasercoagulation of retinopathy and maculopathy. The Diabetic Retinopathy Vitrectomy Study (DRVS)
could show the advantages of timely vitrectomy. Both, the Diabetes Control and Complications Trial (DCCT) and the United
Kingdom Prospective Diabetes Study (UKPDS) could show the value of intensive blood glucose control.
Discussion: 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, although at a lower level of evidence, using today’s
modern means of literature research.