Retina World Congress 2026: Expanding the DME treatment algorithm beyond anti-VEGF

The treatment landscape for diabetic macular edema (DME) has evolved significantly beyond anti-VEGF monotherapy, and clinicians need to adapt accordingly. That was the message from Michael Singer, MD, clinical professor of ophthalmology at the University of Texas Health Science Center in San Antonio, Texas, and director of clinical research at Medical Center Ophthalmology Associates, who addressed the topic at Retina World Congress 2026, May 14 to 17 in Fort Lauderdale, Florida.

Singer noted that for years anti-VEGF therapy was the only option for DME, but that the development of second-generation medicines like faricimab has brought greater attention to the inflammatory cascade. "We know very clearly that 30% of diabetic patients have inflammatory cascade," he said, framing this as a critical consideration for treatment planning.

NEW DAY data and the case for earlier switching

Singer discussed the NEW DAY (NCT04469595) study, which evaluated steroids in a head-to-head trial with anti-VEGF therapy. The study demonstrated that steroids held their own against anti-VEGF and that their side effects were manageable and predictable. Singer noted that the NEW DAY data also showed meaningful OCT drying in patients who had received anti-VEGF, reinforcing that "30% of people need to do something else."

With more treatment options now available, Singer added that the responsibility falls on clinicians to evaluate when a therapy is working and when it is not. "The burden is on the clinician to really say, how do we balance these new choices, and when are they appropriate, and when should we stop doing the same thing over and over and expecting a different result," he said.

Singer highlighted several biomarkers that may help identify patients more likely to respond to steroids over anti-VEGF, including high reflective foci, subretinal fluid, and disorganization of the retinal inner layers. He noted that in other parts of the world where steroids have been incorporated earlier into the treatment algorithm, clinicians are already thinking about switching sooner when signs of chronicity are present.

He encouraged clinicians to consider both short-acting and long-acting steroids as part of a second-generation treatment algorithm for DME, noting that their side effect profile is relatively manageable and that earlier intervention may help preserve photoreceptors and translate into better long-term vision outcomes.