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From the JAMA Network
April 29, 2019

New Findings From Diabetic Retinopathy Clinical Research Retina Network Protocol V Confirm a Role for Focal Laser Photocoagulation or Observation for Eyes With Center-Involved Diabetic Macular Edema and Good Visual Acuity: New Is Not Always Best

Author Affiliations
  • 1Center for Public Health, Queen’s University of Belfast, Belfast, United Kingdom
JAMA Ophthalmol. 2019;137(7):838-839. doi:10.1001/jamaophthalmol.2019.1876

The advent of anti–vascular endothelial growth factor (VEGF) therapy has ushered in an era of optimism and hope in the management of many maculopathies, including diabetic macular edema (DME). In major clinical trials that enrolled patients with center-involved DME, ranibizumab1 and aflibercept2 yielded both superior visual outcomes and improvements in diabetic retinopathy severity after 2 years of treatment compared with macular laser photocoagulation. More recently, the Diabetic Retinopathy Clinical Research (DRCR) Retina Network investigators3 conducted a randomized clinical trial comparing ranibizumab, aflibercept, and bevacizumab, a compounded and less expensive but unlicensed product. They reported no differences in visual acuity (VA) outcomes at 1 or 2 years across all 3 agents for eyes with center-involved DME and slightly impaired vision, defined as a Snellen equivalent of 20/32 to 20/40.3 These studies have underpinned present treatment algorithms and current guidelines from across the world using anti-VEGF agents as standard care in eyes with center-involving DME when VA is 20/32 or worse.

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