Preventing diabetic macular edema (DME) is crucial for individuals with diabetes, as early intervention against risk factors can significantly reduce the likelihood of vision-threatening complications.
Primary prevention of DME focuses on intensive management of diabetes mellitus (DM), including tight control of blood glucose and lipid levels, as well as hypertension and other systemic risk factors. These measures address the underlying contributors to DME development and progression.
The Diabetic Retinopathy Clinical Research (DRCR) Protocol W study explored whether aflibercept injections in eyes with baseline moderate-to-severe nonproliferative diabetic retinopathy (NPDR) could prevent the development of center-involved DME (ci-DME) with vision loss. Vision loss was defined as a ≥10-letter decrease in visual acuity (VA) at one visit or a 5- to 9-letter decrease at two consecutive visits, attributed to ci-DME. Over two years, the cumulative probability of developing ci-DME with vision loss was 4.1% in the aflibercept group compared to 14.8% in the sham injection group. However, there was no significant difference in mean VA between groups; from baseline to the two-year follow-up, sham-treated eyes had a mean change of -2.0 (SD 6.1) letters, while aflibercept-treated eyes changed by -0.9 (SD 5.8) letters (adjusted mean difference 0.5 letters; 97.5% CI, -1.0 to 1.9 letters; P = 0.47). Currently, anti-VEGF injections like aflibercept are not standard for preventing ci-DME.
In summary, while optimizing systemic risk factors remains the cornerstone of DME prevention, ongoing research into targeted therapies like anti-VEGF agents offers promising avenues, though they are not yet routinely recommended.