Time for a paradigm shift in the treatment of DME

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Joshua Mali, MD, a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

The opportunity to improve a patient’s quality of life makes my job very rewarding. As a retinal specialist, I see patients every day who face the debilitating realities associated with retinal conditions such as macular degeneration and diabetic macular edema (DME). My goal is to calm their fears and ease anxiety by offering them the best possible treatment protocols available. 

In recent years, we have experienced tremendous advances in medical technology and pharmacology specific to treating patients who suffer from retinal disease. I continuously seek out and study these new modalities so that I have all the tools currently available to provide my patients with the highest standard of care.

DME therapy: It’s not one size fits all

Well tolerated and effective, anti-VEGF therapy is the current gold standard to treat DME. However, one treatment simply does not fit all and VEGF may just be one piece of a much larger puzzle. The fact that some DME patients have a limited response to anti-VEGF therapy is representative of this concept; we are discovering that there are additional inflammatory mediators that may be crucial components to the DME picture.

Therefore, steroids are an intriguing treatment modality as they are known to affect multiple points along the inflammatory cascade. In addition, patients that have been on monthly anti-VEGF therapy may experience a negative psychological response to the prospect of a monthly needle in their eye, or in younger patients, frequent and repeated downtime from work is not an ideal option. Often, the frequency and expense of the treatment becomes burdensome on the patients, their families, the healthcare system, and on providers. Rather than risk leaving vision on the table for these patients, we must consider alternative therapies such as long-acting steroids and laser photocoagulation, or a combination of these treatment modalities.

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