SOE 2023: Current treatment options for diabetic macular edema

Ala Moshiri, MD, PhD, discusses the various treatment options for patients with diabetic macular edema with Sheryl Stevenson, group editorial director, during the 2023 European Society of Ophthalmology meeting, June 15 to 17 in Prague, Czech Republic. Moshiri is affiliated with University of California, Davis Medical Center.

Video transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: We're joined today by Dr Ala Moshiri, who is presenting at this year's European Society of Ophthalmology. We're delighted to have you with us today. Could you take a few minutes and tell us a little about your talk that you'll be giving?

Ala Moshiri, MD, PhD: I'm happy to do that. Thank you for inviting me. I can't wait to be in Europe with our European colleagues to learn together and discuss all the latest updates in ophthalmology. My specialty area is retinal diseases and at this meeting I'll be speaking briefly about current treatments for diabetic macular edema.

As you know, diabetic macular edema is a major cause of vision loss, particularly in working aged people both in the United States and Europe and across the world. The treatment for it is always evolving. For that reason, an update on treatment modalities and regimens is always of interest to people in our profession.

My presentation will be approximately six minutes, and in that time, I wish to give a very brief review of the original treatments for diabetic macular edema including focal laser and the studies that first showed us that focal laser treatment was effective, followed by the later studies using anti-VEGF medications that have further revolutionized our treatment regimens.

In the anti-VEGF era, we've learned a lot. We have in our hands, in our arsenal or toolbox, however you like to think of it, several different drugs, all of which are effective. We've had studies to compare their efficacy side-by-side, and also to study how frequently we should be treating patients, how long we should be treating patients, and whether or not we should be treating them differently when their presenting visual acuity is quite good or quite bad or in the sort of typical range in which people come to the clinic with vision problems.

I'll be reviewing each of those things and using the best evidence in the published literature to support the statements that I'll be making.

Stevenson: Fantastic. What are the key takeaways that you would wish for the clinician to be able to apply to their practice on Monday morning?

Moshiri: I think the key takeaways are that the mainstay of therapy in 2023 should be anti-VEGF treatment to the eye; that when the visual acuity is quite good, like 20/25 or better at the time of presentation, that observation is a sensible initial management; that when the visual acuity of presentation is quite bad that initiating treatment with aflibercept or other drugs that are essentially aflibercept equivalents is probably appropriate, and that the evidence suggests that frequent therapy achieves the best visual acuity results. Those are really the fundamental takeaways of the presentation.

Stevenson: Is there anything else that we haven't touched upon that you would like to include?

Moshiri: Yes, I would also like to include that there is a role for steroid medications in the treatment of diabetic macular edema, but they should probably be reserved as a second-line treatment, and that select cases still do benefit from focal laser treatment.