People who have center-involved diabetic macular edema (DME) but good vision can reasonably hold off on immediate treatment as long as they are watched closely and treated quickly if vision begins to worsen, according to new research in the Journal of the American Medical Association (JAMA).
The most common cause of vision loss in Americans with diabetic eye disease, diabetic macular edema is swelling of the macula, or the center part of the retina, which can cause blurred vision.
The study included 702 participants with diabetic macular edema and 20/25 vision or better. Subjects were randomly assigned to receive either eye injections with the treatment aflibercept (brand name Eylea) as frequently as every four weeks, laser photocoagulation, or observation to detect changes in vision. Over the course of the two-year trial, aflibercept injections were required in 25% of the laser group and 34% of the observation group, who needed a similar number of injections compared to those who began in the aflibercept group.
At the end of the trial, vision loss did not differ among the groups, with 16% of the aflibercept group, 17% of the laser group and 19% of the observation group meeting a threshold for visual acuity loss.
“Future technology may do a better job of identifying who might benefit from early treatment, before diabetic macular edema affects vision,” noted Adam R. Glassman, MS, director of the study’s coordinating center. “But for now, close monitoring of diabetic macular edema in patients with good vision is an appropriate initial strategy as long as they are closely followed and subsequently treated if vision worsens.”