A better understanding of the pathophysiologic mechanisms of diabetes has resulted in improved control of its local and systemic comorbidities. Further developments are needed, however, considering the growing number of diabetic patients and who are at risk for late-stage diabetic eye disease.
“We have been on a good course, but we still have a long way to go,” explained Justus G. Garweg, MD, Berner Augenklinik am Lindenhofspital, Swiss Eye Institute of Bern, Switzerland. “Promising strategies are being evaluated, and there are a number of biologicals and other drugs in the clinical pipeline.
“Future progress, however, will require very close cooperation with our medical colleagues because combined therapeutic strategies at the systemic and local levels will be needed for managing the different underlying systemic comorbidities,” Dr. Garweg added.
Anti-VEGF injections are considered the standard of care for DME. Results from clinical trials show that on average, patients in real life will gain 7 to 8 letters of visual acuity, with about 50% of patients benefiting with an improvement of 3 or more lines and about 75% having at least a 2-line gain. (Image courtesy of Justus G. Garweg, MD)
Anti-VEGF injections are considered the standard of care for diabetic macular edema (DME), and results from clinical trials show that on average, patients in real life will gain 7 to 8 letters of visual acuity, with about 50% of patients benefiting with an improvement of 3 or more lines and about 75% having at least a 2-line gain.
Achieving these benefits can be demanding, at least in the first year of treatment where patients seem to need up to 9 injections. Data from follow-up through 4 to 5 years show, however, that the injection requirement decreases thereafter.
Dr. Garweg observed that even patients who seem to be responding insufficiently to initial therapy can benefit from ongoing treatment. He noted that perhaps 40% of patients treated with anti-VEGF injections have persistent DME at 6 months.
With continued treatment, 40% of those patients have chronic persistent DME at 3 years. Within the latter subgroup, about 40% of patients will still have gained at least 10 letters of visual acuity, whereas only 13% will have lost 10 or more letters.
“If you stop treating these patients, they will lose any benefit they achieved,” said Dr. Garweg.