Better Treatments for Diabetic Macular Edema

Charles C. Wykoff, MD, PhD


September 27, 2013

In This Article

The Upsurge in Diabetic Macular Edema

Many countries have experienced a startling rise in obesity rates over the past 2 decades. Obesity carries many health-related implications, including an increased risk for diabetes mellitus, which affects an estimated 6.3% of the US population and 4% of the worldwide population.[1] Diabetes often affects the small vasculature of end organs, including the eye. Diabetic retinopathy affects about one half of persons with diabetes and is the leading cause of vision loss and blindness in the United States among working-age people.[2]

Diabetic macular edema results from pathologic capillary permeability related to overexpression of vascular endothelial growth factor (VEGF) and other cytokine mediators.[3] This fluid and exudate accumulation in the portion of the retina responsible for central visual function, the macula, is the most common cause of visual impairment from diabetic retinopathy.

The first treatment proven effective for diabetic macular edema management was focal laser photocoagulation, defined by the landmark ETDRS trial in the 1980s.[4] Focal laser treatment involves applying light, small-sized burns to areas of leaking microaneurysms and thickening within the macula. The primary goal of focal laser treatment is to stabilize visual acuity, because vision improves for only a minority of patients. The risk for moderate vision loss (doubling of the visual angle; for example, a reduction in visual acuity from 20/40 to 20/80) is lowered by approximately 50% with the application of appropriate focal laser treatment.


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