When Not to Treat Diabetic Macular Edema

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Injections of anti-VEGF agents and laser photocoagulation have both been shown to effectively treat people with diabetic macular edema involving the center of the macula (CI-DME) when it impairs vision. Less is known about whether these treatments are effective in people with CIDME who have good vision (20/25 or better) that hasn’t been impaired by the disease.

To get a clearer picture of what the best treatment options may be for such individuals, researchers randomly selected a group of 702 people with diabetic macular edema and good visual acuity. Some were given anti-VEGF injections. Others underwent laser photocoagulation. A third group was simply observed for the duration of the study; if eyesight deteriorated in any of these participants, they were given anti-VEGF treatment.

After two years, there were no significant differences in vision loss among the three groups, according to the results that were published in 2019 in JAMA. Among the study limitations: Because the treatment regimens were different, the schedule of visits for care varied among the groups, which could have affected the outcomes. Also, researchers and patients alike knew which group each patient was in, which could have biased the results.

Still, the findings strongly suggest that as long as visual acuity remains unimpaired, observation without treatment may be a reasonable approach. If you have diabetic macular edema, it’s wise to talk with your doctor about various strategies—including waiting until symptoms worsen.