Treatment of DME poses complex choices, strives to overcome limitations
Diabetic macular edema remains a major concern despite the availability of technology for potentially earlier diagnosis and better options for treatment. The 2016 WHO Global Report on Diabetes showed that 422 million adults currently live with diabetes and that prevalence has almost quadrupled since 1980. This is mainly due to the dramatic rise in type 2 diabetes, which accounts for 90% to 95% of the cases. Inactivity, diet, overweight and obesity are the main causative factors.
As a consequence, the prevalence of diabetic retinopathy (DR) and DME is also expected to rise.
The good news is that the urgency is making research move faster. Current treatment options have been widely investigated, compared and combined, and new options are being tested in the search for increased efficacy and durability, and consequently lesser burden for the patient.
“Treatment options improved immensely over recent years, and that has been driven by the emergence of anti-VEGFs. In a dozen years, they have turned everything around. The AAO Preferred Practice Pattern recommends them as first-line treatment for center-involved DME, with or without adjunct focal laser treatment. While previously focal laser was the primary treatment, anti-VEGF alone can effectively manage about three-quarters or more of center-involving DME cases,” Regillo said.
If response is poor, steroids may be attempted as a second-line treatment, alone or in combination with an anti-VEGF.
“Focal laser is more of a potential backup treatment for most of our patients, and the majority of retinal specialists are using it less and less as time goes on,” he said….
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