Researchers aimed to develop a consensus on the therapeutic objectives and prognostic role of biomarkers in diabetic macular edema (DME) in a report published in Clinical Ophthalmology. The report reviewed several studies from various sources on DME-related treatments, diagnoses, biomarkers, management, and outcomes to develop evidence-based practice recommendations. 

The panel concluded:

  • DME treatment should start as soon as possible in patients whose eyes have visual acuity (VA) worse than 20/25.
  • In patients with good baseline VA, the therapeutic objective should be to maintain acuity and improve it, if possible, while considering the ceiling effect.
  • For patients with low baseline VA, the objective should be to improve VA as much as possible unless the patient has severe retinal damage that could limit functional improvement. In those cases, maintaining vision should be the main objective.
  • From a daily practice perspective, the main therapeutic objective is to achieve the best anatomic response as fast as possible, then check the maximum functional response the patient can get.
  • After administering 3 anti-vascular endothelial growth factor (VEGF) intravitreal injections, “no response” should be defined as persistent or worsening DME or nonimprovement in functional or anatomic outcomes.
  • A naïve patient is defined as a patient who, up to that moment, had never received any treatment.
  • A refractory DME patient may be defined as any who did not achieve a complete resolution of the disease, regardless of the treatment administered.
  • Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic and predictive factors in patients with DME. Therefore, the panel recommends that clinicians assess these biomarkers and consider them when determining therapeutic strategies.

A limitation of this research is the lack of discussion about the cost-effectiveness of treatment options or the social impact of both disease impairment and treatment. 


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Disclosure: Several of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by a grant from Allergan. Please see the original reference for a full list of disclosures.

Reference

Udaondo P, Adan A, Arias-Barquet L, et al. Challenges in diabetic macular edema management: an expert consensus report. Clin Ophthalmol. 2021;15:3183-3195. doi:10.2147/OPTH.S320948

This article originally appeared on Ophthalmology Advisor