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Watching and Waiting With Diabetic Macular Edema: A study suggests that patients with excellent vision can wait to begin DME treatment without compromising outcomes.

About 10 percent of people with diabetes develop diabetic macular edema (DME), a build-up of fluid in the eye that causes blurred vision that can't be improved with corrective lenses. Timing treatment is as much of an art as a science: Treating too soon can expose patients to risks, while waiting too long can result in irreversible vision loss and blindness.

In a new study published in JAMA, researchers from the Diabetic Retinopathy Clinical Research Network put treatment timing to the test and concluded that, in patients with good vision, taking a wait-and-see approach to treatment can yield results that are comparable to starting treatment right away.

The New Findings. The researchers enrolled 702 people with DME who had vision that was 20/25 or better. The participants were randomly assigned to one of three management strategies:

* Injection of aflibercept, an anti-vascular endothelial growth factor (anti-VEGF) medication that blocks the development of new blood vessels and limits leakage from the abnormal blood vessels in the eye.

* Laser photocoagulation to cauterize blood vessels.

* Observation only.

The researchers closely monitored the vision of all participants. If someone in the observation or laser group lost two lines of visual acuity on an eye chart at one visit or lost one line at two consecutive visits, he or she was given aflibercept injections instead.

Over two years, 25 percent of the participants in the laser group and 34 percent in the observation group needed aflibercept injections. When the researchers looked at total vision lost in all three groups over the course of the study, there were no differences. They concluded that the group that was initially only observed fared no worse than the groups that started treatment immediately.

What This Means for You. As long as treatment begins at the earliest sign of vision loss, there is no harm in taking a wait-and-see approach with DME, but the condition should not be left untreated. While it is reversible in the early stages, letting it go too long can cause permanent vision loss. An estimated 20 to 30 percent of patients who do not receive treatment for DME will lose at least three lines of vision within three years.

Simple Steps. Regular eye doctor visits are imperative for detecting any progression or vision loss, but that's not all you can do. The people who are most at risk of developing DME are those with long-standing diabetes, poor glucose control, high blood pressure, fluid retention, and high levels of fats in the blood. To reduce risk, then, it's important to maintain recommended glucose, blood pressure, and cholesterol levels. Eating a healthy diet with plenty of fruits and vegetables and exercising regularly can also help reduce the risk.


About Diabetic Macular Edema (DME)

Diabetes can damage the blood vessels in the retina, the light-sensing tissue at the back of the eye, resulting in diabetic retinopathy. The damaged blood vessels can weaken and leak fluid into the macula and fovea. The macula is near the center of the retina, and the fovea is near the center of the macula. The fluid causes inflammation (macular edema) and impaired central vision. Untreated, it can lead to blindness.

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Title Annotation:OPHTHALMOLOGY
Author:Allingham, Michael
Publication:Duke Medicine Health News
Date:Jul 25, 2019
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