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To the Editor We would like to comment on the implications to clinical practice of an analysis by Ross et al1 examining the cost-effectiveness of aflibercept, bevacizumab, and ranibizumab for the treatment of diabetic macular edema (DME) that was recently published in JAMA Ophthalmology. Protocol T demonstrated aflibercept to be superior to bevacizumab in visual acuity outcomes, especially among patients with at least moderate vision loss (≤20/50), anatomic improvement at all time points regardless of presenting visual acuity, and the need for adjunctive macular laser photocoagulation.2 The retina community has incorporated these results into practice. In the 2015 Preferences and Trends Survey of the American Society of Retinal Specialists, 64.6% of respondents reported aflibercept as their first choice for treating DME in patients with visual acuity worse than 20/50, whereas 22.4% of respondents reported bevacizumab as their first choice (http://www.asrs.org [accessible only to society members]).
Clark WL, Boyer DS, Kaiser PK. Controversies in Using Off-Label Intravitreous Bevacizumab for Patients With Diabetic Macular Edema. JAMA Ophthalmol. 2017;135(3):291. doi:10.1001/jamaophthalmol.2016.5676
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