Diabetic Macular Edema

Diabetic macular edema represents one of the most important causes of visual morbidity in diabetes mellitus. The National Diabetes Information Clearinghouse estimates the prevalence of diabetes mellitus types 1 and 2 at 11.3% of the population above the age of 20, with an annual incidence of 1.9 million cases in the United States alone. In this population, the prevalence of diabetic macular edema is estimated at 30% of patients inflicted by the disease for 20 years or more. Diabetes mellitus is the leading cause of preventable blindness owing to both diabetic macular edema and complications of proliferative diabetic retinopathy (NDIC 2011). Thus once can expect that diabetic macular edema is a common entity in any Retina specialty practice with serious implications for vision loss if not treated in a timely and appropriate manner. Based on the critical findings of the Early Treatment in Diabetic Retinopathy Study, the standard of care has been focal laser photocoagulation therapy along with strong recommendations for strict blood glucose and blood pressure control. However since then, the spectrum of therapies for diabetic macular edema has expanded and continues to evolve. The use of steroid therapy and anti-vascular endothelial growth factor biologics have been compared to focal laser photocoagulation in order to establish more treatment options with equivalent efficacy and safety.