Patient and Physician Perspectives on the Management of Diabetic Macular Edema

Diabetic macular edema (DME; diabetic macular oedma in some countries), which can be associated with diabetic retinopathy, is characterized by macular thickening and accumulation of pathologic fluid in the portion of the retina responsible for central vision. DME is a leading cause of vision loss in individuals with diabetes and can severely impact their daily activities and quality of life. Standard DME treatment involves intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents, and some patients receive laser photocoagulation and/or intravitreal corticosteroid injections. Anti-VEGF injections can pose considerable burdens for patients and caregivers, with the need for frequent injections and face-to-face clinic appointments, and have limited effectiveness or durability in some patients. To highlight challenges for patients with current treatment options and support a basis for research on new treatments, two people with DME and two expert physicians collaborated on this patient-led manuscript. Together, they explored the real-world experiences and perspectives of the patient authors and reviewed the relevant DME literature. Many of the experiences with current injectable DME treatments of our patient authors and other patients they know aligned with the literature. They noted the benefits of face-to-face clinician contact for injections and the substantial burdens associated with appointments, difficulties caused by comorbid eye conditions, pain and anxiety related to injections, treatment effectiveness limitations, and the need for novel therapies. These insights and perspectives will enable patients and clinicians to better understand current challenges around injectable anti-VEGF treatments in DME, how future developments might address patients' treatment needs, and how best to support patients with DME receiving anti-VEGF treatment to minimize its impact and burdens.