Treating Advanced Diabetic Macular Edema: Experts Discuss Recent Advances in Treatment

Diabetic macular edema (DME) is a serious eye condition that can lead to vision loss or blindness if left untreated. Fortunately, recent years have seen dramatic advances in DME treatments that have improved outcomes for patients. In this two-part series, four experts in diabetic retinopathy and DME discuss the latest treatment options and how they affect patients with advanced DME.

Primary Treatment Methods: Anti-VEGF Medications and Steroids

The primary treatment methods for advanced DME are intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. According to Dr. Coates, these medications are highly effective and work well for most patients. However, around 10-15% of patients don’t respond well to anti-VEGF treatments.

If a patient is not responding to anti-VEGF treatment, intravitreal steroid injections or focal laser photocoagulation can be considered. Steroids have the advantage of working on multiple inflammatory pathways that can contribute to DME. According to Dr. Prasad, the durability of these treatments may also be longer than anti-VEGF pharmacotherapy. However, intraocular steroid benefits must be weighed against the risk of side effects, including intraocular pressure elevation and cataract progression.

Surgical Options

Focal laser photocoagulation is the primary surgical option for patients with DME. According to Dr. Coates, its use has decreased significantly over the past 10-15 years. However, macular laser photocoagulation can be useful in select patients with DME to decrease their need for ongoing injections or to treat recalcitrant DME.

Pars plana vitrectomy is another surgical option for DME, but there is debate over its effectiveness. Research from the Diabetic Retinopathy Clinical Research Retina Network demonstrates no significant improvement in visual acuity between eyes that have had a vitrectomy versus those that have not.

A newer surgical treatment involves a surgically implanted device that acts as a reservoir for anti-VEGF medication. According to Dr. Prasad, the medication slowly releases into the vitreous cavity, providing a long-term steady-state level of anti-VEGF medication. Instead of needing intravitreal injections every four to six weeks, patients can have this device refilled in the clinic every 6 months.

Future Research

One novel approach being investigated involves the possible long-term benefits of injecting sustained-release anti-VEGF medications even before diabetic retinopathy and DME manifest and whether doing so improves overall visual outcomes. Making medications last longer is a current research effort. Also, treatments, regardless of their duration, are typically repeated, so in the real world, loss to follow-up is fairly high.

Prevention and Early Detection

Patients with DME need to be identified and treated early in their disease course to avoid irreversible vision impairment. Healthcare providers outside eye care need to ensure that patients with diabetes, especially if poorly controlled, are being screened at least annually with a dilated fundus exam by a qualified eye care provider. According to Dr. Prasad, evidence is growing that newer categories of oral hypoglycemic agents can increase the risk for DME. Also, systemic illnesses, including anemia, infections, and renal dysfunction, can negatively impact diabetic retinopathy and DME. Ophthalmologists, primary care physicians, and endocrinologists need to be in close communication regarding changes in medications or systemic health that can impact their patients’ ocular health.

The Importance of Long-Term Patient Relationships

In diabetes, the retina may look normal on examination. But in-depth analysis such as OCT may detect very early subtle changes the human eye cannot see. These changes may be on a molecular or cellular level beyond our current understanding. As Dr. Liu notes, doctors need to explain to each patient with diabetes that diabetes, diabetic retinopathy, and DME are chronic and that to ensure optimal outcomes, we need to maintain a long-term relationship.

Conclusion

Recent advances in DME treatments have dramatically improved outcomes for patients with advanced DME. Anti-VEGF medications are the primary treatment method, but intravitreal steroid injections or focal laser photocoagulation can be considered for non-responsive patients. Surgical options include focal laser photocoagulation, pars plana vitrectomy, and surgically implanted devices that act as a reservoir for anti-VEGF medication. Future research is focused on making medications last longer and improving follow-up rates. Prevention and early detection are critical, and healthcare providers need to be in close communication regarding changes in medications or systemic health that can impact ocular health. To ensure optimal outcomes, doctors need to maintain a long-term relationship with each patient.

Long Tail Keywords

Advanced diabetic macular edema treatments
Intravitreal injections of anti-vascular endothelial growth factor medications
Intravitreal steroid injections
Focal laser photocoagulation for DME
Surgically implanted device for anti-VEGF medication
Pars plana vitrectomy for DME
Preventing diabetic macular edema
Early detection of DME
Importance of long-term patient relationships in treating DME

Originally Post From https://www.physiciansweekly.com/qa-part-2-advances-unmet-needs-in-diabetic-macular-edema-treatment/

Q&A Part 2 Advances & Unmet Needs in Diabetic Macular Edema Treatment