COMMENTARY

Better Treatments for Diabetic Macular Edema

Charles C. Wykoff, MD, PhD

Disclosures

September 27, 2013

In This Article

Combination Treatments for Diabetic Macular Edema

Thus far, anti-VEGF pharmaceuticals, with or without focal laser treatment, have proven the most effective and safe treatments for regaining vision lost because of diabetic macular edema. But these therapies carry a significant burden, with patients undergoing evaluation and treatment every month or at least every other month after an initial series of monthly treatments. Much research is dedicated to reducing this treatment burden while maintaining optimal visual outcomes.

For example, selective peripheral photocoagulation of areas of retinal nonperfusion, as guided by wide-field fluorescein angiography, may reduce ocular VEGF levels and thereby indirectly ameliorate VEGF-dependent pathologies, such as diabetic macular edema. This concept is being actively investigated in many trials, including the DAVE randomized trial.[19]

Other ongoing studies aimed at lowering the treatment burden for patients with diabetic macular edema include combining anti-VEGF therapy with focal laser treatment targeted to leaking microaneurysms using an fluorescein angiography-guided focal laser treatment system[20] (Navilas®, OD-OS, Teltow, Germany) and comparing a treat-and-extend regimen with monthly therapy.

Improving the Treatment Burden

Diabetes-associated vision loss is an enormous public health concern. Fortunately, excellent clinical options are available for the treatment of diabetic retinopathy, including diabetic macular edema. New pharmaceutical treatments that may become FDA-approved (such as aflibercept and the fluocinolone acetonide implant), as well as a more complete understanding of the role of focal and panretinal photocoagulation, will certainly translate into continued visual benefit and an improved treatment burden for our patients with diabetic macular edema.

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