First-line treatment for diabetic macular edema (DME) is overwhelmingly anti-vascular endothelial growth factor (VEGF) drugs, with more than two-thirds of clinicians around the world prescribing them for this patient population.
Clinicians in Africa and the Middle East lead the way with 91% of clinicians prescribing anti-VEGF drugs as the primary treatment for DME followed by the United States at 87%, Central and South America at 64%, and European clinicians at 63%.
There is also a role for treatment with steroids for patients who are refractory to anti-VEGF therapy with an increase of only a few letters of vision and those with persistent edema among others, said Anat Loewenstein, MD, MHA.
However, the disease pathogenesis-which is complex and involves both the vascular and neural components-is enhanced by increased leakage of inflammatory cytokines, explained Dr. Loewenstein, professor of ophthalmology and deputy dean of the medical school, Sackler Faculty of Medicine, Tel Aviv University, and chairman of the ophthalmology division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
"Steroids that inhibit these cytokines theoretically and potentially have a role in the management of DME," she said.
Anat Loewenstein, MD, MHA
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This article was adapted from Retina Subspecialty Day during the 2017 meeting of the American Academy of Ophthalmology. Dr. Loewenstein serves as a consultant to Allergan, Bayer Healthcare Pharmaceuticals, Notal Vision Inc., ForSight Labs, and Novartis Pharmaceuticals Corp.