Epidemiology of Treated Diabetes Ocular Complications in France 2008–2018—The LANDSCAPE French Nationwide Study

Round 1

Reviewer 1 Report

line 56-57 “aged 50 years and older” OK

line 67 “from 15 years post-diagnosis” OK

line 85-86 “since 2012 for ranibizumab, since 2015 for aflibercept and dexamethasone implant”; surely the data before 2012 cannot be compared with those after.

line 93 “between 2008 and 2018” OK

line 117 “identified using a validated algorithm” what algorithm ?

line 120-121 “excluded if they were aged ≥80 years at the first treatment (to exclude nAMD patients)” OK. Maybe extracted from another study where the average age of treatment was this?

line 148-149 “Treated prevalence was calculated as the number of prevalent treated DME and PDR patients in the calendar year 2018” OK

line 153-154 “Comorbidities between 2008 and 2018 were only described for incident patients in 2018” OK.

it would have been useful to do a 2015-2018 study by collecting data from four years or just 2018.

The limitations of the study are indicated very well in the conclusions. Overall the study is well done, only minor corrections are needed.

 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Page 2:

Incidence unit, “DME incidence in 2018 was 0.025%”, instead of 0.025%, better be appeared as 2.5 (DME events) per 10,000 persons. Usually report rates (incidence or prevalence), should also report 95% confidence interval.

Similarly, “Prevalence in 2018 was 0.095% and 1.437% in the respective populations.”, better be 9.5 and 143.7(DME events) per 10,000 persons.

“Treated DME incidence rose from 2012-2018 whereas treated PDR incidence was relatively stable from 2008-2018.” – What is the reason to keep it stable?

Page 4:

“Incidence was calculated as the number of newly treated DME and PDR patients over the calendar year as a percentage of the French general population aged ≥18 years in that year” – instead of percentage – usually should be events per XXX persons. 95% confidence interval should also be reported.

Page 5:

Table 1: Since there are two groups – why not perform statistical tests, report p-value or standardized difference comparing if there were significant different between each characteristics?

Table 2 title should be on page 6

Page 6:

Table 2 numbers should be format as XX.X (one digit) per XXX persons – easier for reader to comprehend.

Page 7 and 8:

All figures y-axis label should be unified.

‘per 100 population’ should be ‘per 100 persons’

95% confidence interval of incidence and prevalence should also be reported.

Page 13:

Figure 1 “Treated DME in the diabetic population” increasing dramatically. Why not discuss more in the DISCUSSION and mention it in the conclusion?

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

Title: Estimation of incidence and prevalence of diabetes ocular complications in France from drugs consumption data over the last decade – the LANDSCAPE French nationwide study  

Comments: This is a laboratory-based study which evaluates the compounds present in the Ponciiri Fructus dried fruit, a well known and used traditional Korean medicine for treatment of allergy and gastrointestinal disorders. The study focuses on extracting compounds from PF for evaluation of anti-inflammatory properties by inhibiting of free radical production in the LPS stimulated macrophage in dose dependent manner. The study evaluated the amount/dose of effective of these compounds. Overall the incorporation of the use of plant extracts in modern medicine is becoming highly popular with promising results.

1.    The title is very elaborate – incidence and prevalence all fall under the category of cross-sectional studies: thus the title can be shorten by Cross-section study of diabetes ocular complications …

2.    Background: The background provides pathogenesis of DMA and RDR which are known processes. This should be eliminated.  

a.    The background should include a brief mention of the incidence and prevalence of other previous studies that have been conducted

                                               i.     Line 90 mentions the extensive literature detailing the prevalence and incidence of diabetes in France for DME and PDR should be briefly mentions to give the readers a bit of the background of the studies

b.    The layout of the paragraphs needs to reviewed and rewritten

                                               i.     Paragraph one – line 54 starts with a however which seems very inappropriately placed and multiple other areas as well

3.    The aims of the study should be more detailing with a relevant rationale, instead of just stating to ‘address this gap’

4.    Methodology:

·       The method of data sources are adequately described

·       Identification of treated DME and PDR patients – exclusion and inclusion criteria were stated. Definition of the patient was adequately stated

5.    Results:

·       The description of results are systematic and not heavily described in text.

·       Please keep the follow equal – range in table 1 is used with a (18.0,79.0) and with a (18.0-99.0)

·       Table 2 is not labelled and is not understandable. This can be presented in a much easy to understand manner. This table also shows that a relative risk can be used to get significant data for reporting.

·       The figures and tables should be labelled and captioned appropriately

·       The graphs can be merged reducing bulk in the result section such as figure 2 and 3

6.    Discussion:

·       The discussion was written poorly

o   The study limitation describes in the third paragraph on line 280

·       The discussion should be restructured and rephrase

o   The studies should be briefed instead of just stating the ‘need statistics’ such as line 339 to 341.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Good improvement after version 2 modification.