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Royle P, Mistry H, Auguste P, et al. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2015 Jul. (Health Technology Assessment, No. 19.51.)

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

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

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Appendix 2Search strategies

Search strategies

In order to capture the wide range of evidence relating to PRP, other forms of laser treatment, and drug treatments in the treatment of all stages of DR, 10 separate types of search (as outlined below) were designed and performed:

  1. systematic reviews and meta-analyses of PRP for DR
  2. RCTs for treatment of DR
  3. all studies on NPDR
  4. all studies on lasers in DR
  5. progression or natural history of DR
  6. side effects of lasers from non-RCT studies
  7. QoL in DR after PRP
  8. cost-effectiveness of treatment in DR
  9. ongoing or recently completed research
  10. additional sources searched.

(a) Searches for previous systematic reviews or meta-analyses on the treatment of diabetic retinopathy

Ovid MEDLINE 1946 to August Week 2 2013

  1. exp *Diabetic Retinopathy/
  2. (diabet* and retinopathy).m_titl.
  3. 1 or 2
  4. (systematic review or meta-analysis).tw.
  5. meta-analysis.pt.
  6. 4 or 5
  7. 3 and 6

EMBASE 1980 to 2013 Week 34

  1. exp *Diabetic Retinopathy/
  2. (diabet* and retinopathy).m_titl.
  3. 1 or 2
  4. (systematic review or meta-analysis).tw.
  5. 3 and 4

Cochrane Database of Systematic Reviews July 2013

(diabet* and retinopathy) in Title

(b) Searches for randomised controlled trials for the treatment of diabetic retinopathy

These searches included all aspects of treatment – including laser surgery and drug treatment.

Ovid MEDLINE 1946 to August Week 2 2013; Ovid MEDLINE In-Process & Other Non-Indexed Citations August 26, 2013

  1. exp *Diabetic Retinopathy/
  2. (diabet* and retinopathy).m_titl.
  3. randomized controlled trial.pt.
  4. random*.tw.
  5. 3 or 4
  6. 1 or 2
  7. 5 and 6
  8. 1 or 2
  9. 3 or 4
  10. 5 and 6

EMBASE 1974 to 2013 August 27

  1. exp *diabetic retinopathy/
  2. (diabet* and retinopathy).m_titl.
  3. 1 and 2
  4. (random* adj3 trial*).tw.
  5. (random* adj3 control*).tw.
  6. 4 or 5
  7. 3 and 6

The Cochrane Library

Cochrane Central Register of Controlled Trials: Issue 7 of 12, July 2013.

Search strategy “diabetic retinopathy” in title, and laser or photocoagulation or photo-coagulation in title abstract keywords in Trials”.

After deduplication, resulted in 383 in the database and 92 were selected for full text.

Additional searches for non-randomised controlled trial evidence

(c) Searches for studies on non-proliferative diabetic retinopathy

Additional searches of any study design were done to find any studies that specifically mentioned DR at the non-proliferative or pre-proliferative stage, in order to find additional information for the clinical background section or data on progression or natural history. The searches below were run and downloaded into EndNote and resulted in 928 records in the database after removal of duplicates; the full text of 59 articles was requested and further examined.

Ovid MEDLINE 1946 to August Week 2 2013; Ovid MEDLINE In-Process & Other Non-Indexed Citations August 27, 2013

  1. ((non-proliferative or nonproliferative or preproliferative or pre-proliferative) adj3 retinopathy).tw.
  2. early retinopathy.tw.
  3. NPDR.tw.
  4. 1 or 2 or 3
  5. exp *Diabetic Retinopathy/
  6. 4 and 5
  7. limit 6 to English language

Ovid EMBASE 1974 to 2013 August 27=569

  1. ((non-proliferative or nonproliferative or preproliferative or pre-proliferative) adj retinopathy).tw.
  2. early retinopathy.tw.
  3. NPDR.tw.
  4. 1 or 2 or 3
  5. exp *Diabetic Retinopathy/
  6. 4 and 5
  7. limit 6 to English language

(d) Searches for studies on laser in diabetic retinopathy

Ovid MEDLINE 1946 to August Week 2 2013, Ovid MEDLINE In-Process & Other Non-Indexed Citations August 27, 2013; EMBASE 1974 to 2013 August 27

  1. exp *diabetic retinopathy/
  2. diabetic retinopathy.m_titl.
  3. (laser or photo-coagulation or photocoagulation or panretinal or pan-retinal or PRP).m_titl.
  4. 1 and 2
  5. 3 and 4
  6. limit 5 to English language

The Cochrane Library

Cochrane Central Register of Controlled Trials: Issue 8 of 12, August 2013.

There are 79 results from 71,0762 records for your search on “(laser or photocoagulation or photo-coagulation) and diabetic retinopathy and (NPDR or non-proliferative or non-proliferative or pre-proliferative or preproliferative) in title abstract keywords in Trials”.

(e) Searches of progression of diabetic retinopathy

These searches below were done to inform the background section and the model.

EMBASE 1974 to 2013 September 19; Ovid MEDLINE 1946 to September Week 2 2013; Ovid MEDLINE In-Process & Other Non-Indexed Citations September 19, 2013

  1. diabetic retinopathy.m_titl.
  2. exp Disease Progression/
  3. (progression or natural or course).m_titl.
  4. exp Diabetic Retinopathy/
  5. 1 and 4
  6. 2 and 3 and 5
  7. limit 6 to English language

Resulted in 300 records.

(f) Searches for adverse effects of lasers from non-randomised controlled trial studies

The EndNote database created from previous searches for PRP and lasers was searched using the following keywords:

(adverse or risk* or harm* or side effect* or safety or pain or visual loss or complication*) and (laser or (photocoagulation or panretinal or pan-retinal or scatter or PRP).

The results of this search were then supplemented with searches of MEDLINE and EMBASE.

Ovid MEDLINE 1946 to November Week 3 2013

  1. exp Diabetic Retinopathy/
  2. Laser Coagulation/ae, ct [Adverse Effects, Contraindications]
  3. 1 and 2
  4. limit 3 to English language

EMBASE 1974 to 2014 Week 02

  1. exp Diabetic Retinopathy/
  2. exp laser coagulation/ae [Adverse Drug Reaction]
  3. limit 1 to English language

(g) Quality of life searches for diabetic retinopathy after pan-retinal photocoagulation

Searches of existing databases created from the previous searches above were done using the keywords ‘quality of life’ and ‘laser or photocoagulation’. These records were exported into a new EndNote database and also supplemented with the following database searches.

Ovid MEDLINE In-Process & Other Non-Indexed Citations February 10, 2014; Ovid MEDLINE 1946 to January Week 5 2014; EMBASE 1974 to 2014 February 10 – Retrieved 36

  1. exp “Quality of Life”/
  2. quality of life.tw.
  3. 1 or 2
  4. exp Laser Coagulation/
  5. (laser or photocoagulation).tw.
  6. 4 or 5
  7. 3 and 6
  8. limit 7 to English language
  9. exp Diabetic Retinopathy/
  10. diabetic retinopathy.mp.
  11. 9 or 10
  12. 8 and 11
  13. limit 12 to English language

The resulting EndNote database had 80 references, of which 16 were selected for the section on the quality for DR after PRP.

(h) Searches for ongoing or recently completed research

Searches were done on 16 January 2014 using the keywords “diabetic retinopathy AND (laser OR photocoagulation OR PRP OR scatter)”.

Sources searched were ClinicalTrials.gov, WHO, Clinical Trials Registry Platform Search Portal, Current Controlled Trials, UK Clinical Trials Gateway, EU Clinical Trials Register, UK Clinical Research Network Study Portfolio.

Selected those where the condition being studies was diabetic retinopathy (but excluded those where it was only DMO) and the intervention included scatter or PRP laser alone or in combination with something else and where the results had not been found published in full or as a meeting abstract. Selected only those that had a RCT study design – apart from one observational study.

Also searched the Association for Research in Vision and Ophthalmology (ARVO) meeting abstracts website for recently completed RCTs from 2002 to present using the keywords (randomized and laser) or (randomized and photocoagulation) and selected those that were published between 2011 and 2013 and which were about PRP laser for DR.

(i) Cost-effectiveness search strategies

MEDLINE and EMBASE searches

  1. exp quality adjusted life year/
  2. quality adjusted life year.mp.
  3. (QALY or QALYs).mp.
  4. utilit$.mp.
  5. (EuroQol or Euro Qol or Euro-Qol or EQ 5D or EQ5D or EQ-5D).mp.
  6. (health utilities index or health-utilities-index or HUI).mp.
  7. (SF 6D or SF6D or SF-6D).mp.
  8. (short form 36 or short-form 36 or SF 36 or SF36 or SF-36).mp.
  9. (quality of wellbeing or quality of well-being or QWB).mp.
  10. (healthy years equivalent or hyes or hye).mp.
  11. (time trade off or time trade-off or time-trade-off or TTO).mp.
  12. (standard gamble or standard-gamble or SG).mp.
  13. (15 D or 15D).mp.
  14. ((willing$ adj2 pay) or WTP).mp.
  15. Health Status/
  16. exp Quality of Life/
  17. (quality adj2 life).mp.
  18. (health state* or health status).mp.
  19. (hrql or hrqol or disability$ or disutility$).mp.
  20. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19
  21. exp Cost-Benefit Analysis/
  22. (cost effective$ or cost-effective$).mp.
  23. (cost utility$ or cost-utilit$).mp.
  24. (cost benefit$ or cost-benefit$).mp.
  25. (willingness to pay or wtp or willingness-to-pay or willingness to accept or willingness-to-accept or net benefit or net-benefit or contingent valuation).mp.
  26. (Pharmacoeconomic$ or pharmaco-economic$ or Economic analy$ or Economic evaluation$).mp.
  27. (economic adj2 (evaluation$ or analy$ or study or studies)).mp.
  28. (cost adj2 (evaluation$ or analy$ or study or studies or effective$ or benefit$ or utili$)).mp.
  29. ((markov or decision) adj2 model).mp.
  30. 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29
  31. exp cost$/
  32. exp Economics/
  33. cost*.tw.
  34. (resource adj2 unit).mp.
  35. (resource adj2 item).mp.
  36. resource$.mp.
  37. 31 or 32 or 33 or 34 or 35 or 36
  38. 20 or 30 or 37
  39. diabetic retinopathy.m_titl.
  40. exp Diabetic Retinopathy/
  41. 39 or 40
  42. 38 and 40
  43. limit 42 to English language

Web of Knowledge/Web of Science

diabetic retinopathy AND (“quality of life” or Qol or hrqol or quality adjusted life year* or QALY* or cost* or economic* or pharmacoeconomic* or model* or euro-qol or utilit* or EuroQol or Euro Qol or EQ5D or EQ-5D or SF-36 or SF36 or time trade* or TTO or standard gamble or markov or visual analog* or discrete choice or health stat* or “willingness to pay”).

(j) Additional sources searched

  • Auto-alerts Weekly auto-alerts in Ovid MEDLINE and EMBASE were run for all of the above search strategies from August 2013 to March 2014 in order to capture new studies added after the initial searches.
  • Value in Health website Also searched the website of the journal Value in Health using the search term “diabetic retinopathy” in the title or abstract for full text articles and meeting abstracts.
  • ARVO meeting abstracts Searched the ARVO website for meeting abstracts (2002 to present) indexed in the Investigative Ophthalmology & Visual Science (IOVS) journal using the keywords “diabetic retinopathy and (laser or photocoagulation or PRP)”.
  • Contact with authors Contacted authors of some published and ongoing trials for further clarification.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Royle et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK305091
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