Rishi Singh, MD: Myths Surrounding Diabetic Macular Edema

During conferences like the American Academy of Ophthalmology (AAO) 2019 Annual Meeting in San Francisco, late-breaking news and real-world clinical data circulates among clinicians as quickly as wildfire—the only thing that sometimes spreads more quickly are myths and misconceptions about diseases.

While this year’s conference was loaded with new studies on topics from burnout to novel therapies, many practicing ophthalmologists will still have to combat the negative impact of some of these myths when they return to their practices.

Rishi Singh, MD, staff physician at Cole Eye Institute of the Cleveland Clinic, explained at AAO 2019 that a lack of understanding the myths surrounding some conditions, like diabetic macular edema(DME), can lead to decision-making that negatively impacts patients.

For more on the most common myths surrounding treatment of DME, MD Magazine sat down with Singh between sessions at AAO 2019.

MD Mag: What are some of the most common myths surrounding treatment of diabetic macular edema?

Singh: So, I think there are a lot of myths with taking care of patients who have diabetes and diabetic macular edema. The first is that I think that angiography is probably the gold standard still for determining retinopathy. We haven't got as good as we could with OCT-A and looking at wide field imaging and wide field impact. What we realize is that there are a lot of non-perfusion that we don't necessarily see on clinical examination and that non perfusion can also mask neovascularization.

So, I think the first myth is that ultra-wide field imaging can be really quite helpful at looking at patients and just don't discount the patient because they have no evidence of proliferative disease.

The second is that we see that persistent fluid in patients with DME and whether that early treatment and those patients really makes a difference. The Protocol V study came out recently and showed that even patients with good vision 20/25—or even better—that there was no impact on the final visual outcome by treating patients early versus waiting for them to decline and then treating them.

So, I think the other thing to think about there is, again, anatomy doesn't always correlate with the vision and those patients and certainly didn't have an impact on that.

The last piece is just around the surveillance of patients and the treatment of retinopathy. We see patients who have a nice impact as far as retinopathy improvements, though I don't think it's hit clinical practices.

Right now, I think there's a lot of barriers to treating retinopathy in current medical practice. More research needs to be done to help alleviate those barriers so our patients can get treated for retinopathy over time.