OSLI Retina

November/December 2015 supplement

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November/December 2015 · Vol. 46, No. 10 (Suppl) S5 ABSTRACT: Diabetic macular edema (DME) is one of the most common causes of vision loss in patients who have diabetes, and all of these patients are at risk for developing DME. The onset is often pain- less, difficult to detect, and can occur at any stage of diabetes. Ideally, DME is preventable, but treat- ment must be considered when preventative meth- ods fail. Although physicians have several differ- ent treatment options for patients with DME, some patients who receive treatment can respond poorly and may even lose vision. Until recently, laser photocoagulation was regarded as the standard of care for DME; however, pharmaceutical treatments are rapidly replacing this standard as the desire to maximize systemic treatment of DME increases. A panel of experts gathered during the 2015 annual meeting of the Association for Research in Vision and Ophthalmology for a roundtable discussion de- signed to focus on improving outcomes for patients with DME using pharmaceutical treatment, includ- ing the use of anti-VEGFs and corticosteroids, based on the most current research and clinical data. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:S5-S15.] INTRODUCTION Pravin U. Dugel, MD: Diabetes is an epidemic. In the United States alone, the growth rate of this disease is projected to be 165% by the year 2050. 1 Perhaps one of the most devastating and impactful consequences of this disease is the loss of sight. Indeed, the main cause of blindness — diabetic macular edema (DME) — is progressive and insidious. Fortunately, recent thera- peutic measures appear promising. In this roundtable symposium, we are here to discuss new paradigms in the treatment of DME. What is your examination process for diagnosing a patient with DME? DIAGNOSING DME Szilárd Kiss, MD: For a patient with diabetes, I typi- cally perform a comprehensive dilated examination with indirect ophthalmoscopy. In addition, for both diagnostic as well as documentation purposes, I ob- tain an optical coherence tomography (OCT) scan and an ultrawide-field fundus photograph. If the hemoglo- bin level is elevated above 10 g/dL and/or I suspect additional pathology on my examination, I also obtain an ultrawide-field fluorescein angiogram. It is amaz- ing how much pathology is revealed on an ultrawide- field fluorescein angiogram that is not obvious from an examination or photography. Dugel: What are the related risk factors for patients with DME? Kirk Packo, MD: There are a great number of risk fac- tors for DME, both proven and speculative. The only proven risk is that of glycemic control — the worse the control, the higher the risk of retinopathy. 2-4 Other fac- tors such as renal status, blood pressure control 5 and lipid status 6 all strongly suggest a role for DME de- velopment, but have lower than class I level of scien- tific evidence. Other less-proven, but potentially im- portant, risks include hormonal imbalances, platelet function, and inflammation. Elias Reichel, MD: The most significant risk factors associated with DME include glycemic control and duration of diabetes. Hypertension, dyslipidemia, and kidney disease are also important factors that Improving Outcomes for Patients With Diabetic Macular Edema

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