Diabetic retinopathy remains the most frequent cause of newly diagnosed blindness in the working-age population. This is despite improvements in therapies for blood glucose and blood pressure control, and the many different treatment modalities that are currently available including laser, vitreous surgery, and intravitreal injections.Diabetic macular edema (DME) is the most common reason for loss of reading vision in diabetes patients. After 15 years of known diabetes, DME is present in 20 % of patients with type 1 diabetes mellitus (DM) and in 14 % of patients with type two DM who do not take insulin. DME is present in 30 % of patients who have had diabetes for longer than 20 years. In eyes with mild non-proliferative diabetic retinopathy, the prevalence of DME is 3 %, rising to 38 % in eyes with moderate to severe non-proliferative retinopathy, and to 71 % in eyes with proliferative retinopathy.
AbstractDiabetic macular edema (DME) is the most common reason for the loss of reading vision in diabetes patients. Systemic control of blood sugar, blood pressure, and lipids is an important aspect of the management of DME. In these patients, macular laser photocoagulation has been shown to reduce the incidence of moderate visual loss by 50 %. Significant visual improvement occurs in a small minority. Other treatment modalities, such as intravitreal steroids and anti-vascular endothelial growth factor (VEGF) drugs, have become increasingly popular. Case series and small clinical studies are suggestive of a beneficial effect, while large-scale clinical trials are ongoing. Currently, it appears that macular laser photocoagulation remains the gold standard for the treatment of DME. Intravitreal steroids and anti-VEGF agents are useful adjuncts that may improve visual outcomes. Current treatments and ongoing clinical trials are discussed.