Diabetic macular edema

A change to the approach for treating diabetic macular edema may on the way; The study was conducted by the DRCR Retina Network, a multicenter clinical research network funded by the National Eye Institute; part of the National Institutes of Health (NIH). The study found that people with diabetic macular edema; who still have good vision, as measured by standard exam with an eye chart; can safely forego immediate treatment of their macular edema as long as they are closely monitored; and treatment begins promptly if vision worsens.

The diabetic eye disease

Diabetic macular edema is the most common cause of vision loss among people with diabetic eye disease in the United States. Diabetes can result in the development of leaky blood vessels in the retina the light-sensing tissue at the back of the eye. Diabetic macular edema is the result of fluid build-up in the central area of the retina, called the macula; which is important for sharp vision. Swelling of the macula can distort the vision required for reading and driving.

According to a statement released by the National Eye Institute; the evidence from this study should help physicians and patients navigate a common conundrum in ophthalmology; Treating diabetic macular edema in people who still have a good vision too soon may subject them to unnecessary costs and risks associated with treatment. Other patients who get treatment too late might risk losing vision permanently.

Detection of visual acuity

During the two-year study; the detection of visual acuity loss prompted aflibercept injections to give to the people in the laser or observation groups. Aflibercept injections thus required among 25% of the laser group and 34% of the observation group. Eyes that started aflibercept injections in the laser and observation groups required a similar number of injections overall compared to the group initially assigned to aflibercept.
Therefore the researchers checked participants’ visual acuity throughout the study at regular follow-up visits in retina specialty clinics. Researchers measured visual acuity in the laser and observation groups at eight and 16 weeks after study entry; then every 16 weeks unless their visual acuity worsened. After two years, the percentage of participants whose study eye met a prespecified threshold for visual acuity loss; one or more lines on an eye chart did not differ among the groups: 16% of the aflibercept group, 17% of the laser group, and 19% in the observation group.
The average visual acuity, which was 20/20 at baseline; remained 20/20 in all three groups at two years. “Future technology may do a better job of identifying who might benefit from early treatment before diabetic macular edema affects vision. “But for now, close monitoring of diabetic macular edema in patients with good vision is an appropriate initial strategy as long as they are closely followed and subsequently treated if vision worsens.”