Clinical Management of Diabetic Macular Edema - Episode 5
A professor of ophthalmology describes how concomitant conditions with diabetic macular edema affect the urgency of treatment regimens.
Nancy Holekamp, MD: We discussed how diabetic macular edema [DME] isn’t urgent, but in some cases we need to engage patients in treatment sooner rather than later. Can you discuss the things that can comigrate with diabetic macular edema that lead to a more urgent situation?
Theodore Leng, MD, FACS: We make a distinction in the retina field between what we call center-involved DME and non-center-involved DME. You could have swelling and leakage outside the foveal center, not center involved; the vision can be good, and the patient can be asymptomatic. In those cases we want to observe because once we start a patient on therapy it’s a commitment on their part and on our part to put them through an intense experience. They will come into our offices monthly for short and possibly long term. While they receive a significant visual benefit to that experience, it’s a commitment. DME affects younger patients in our society; people with jobs, younger families, and other commitments—it’s a burden to ask them to commit to this type of treatment. I take that decision very seriously when I suggest that we start therapy, and if we do, I want them to commit to the full therapy to get the maximum benefit for their vision. Looking for the involvement of the foveal center in OCT [optical coherence tomography] is a key criterion that may indicate treatment. Concurrent problems, such as a proliferative state of disease of the eye, would also be an indicator for treatment with medications. Several studies have shown that the use of these medications can reverse and halt the progress of the proliferative disease and prevent bleeding in the eye, retinal attachment, other irreversible causes of vision loss, in addition to proving the DME at the same time. If a patient has signs of advanced diabetic retinopathy with DME, we suggest and encourage that they begin therapy.
Nancy Holekamp, MD: Thanks to all of you for this rich and informative discussion, and thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box.
Transcript edited for clarity.