Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Oedema: Is It Effective?

Abstract

Diabetic macular oedema (DMO) is a common ocular problem among patients with diabetic retinopathy, which is sight-threatening and leads to blindness. The gold standard treatment for DMO had been focal/grid laser photocoagulation that achieved stabilisation of disease progression. However, newer pharmacological treatment options have gradually been favoured, as studies demonstrate their superior efficacy with regard to significant visual improvements. In particular, use of anti-vascular endothelial growth factor (anti-VEGF) has become very popular, with promising evidence emerging from numerous trials regarding efficacy and safety. Based on the 2014 American Society of Retina Specialists (ASRS) Preferences and Trends survey, the current preferred first-line therapy for DMO is in fact an anti-VEGF agent. Studies have shown that VEGF plays a critical role in both the angiogenesis and inflammation processes that occur during development of DMO. Hence, this allows anti-VEGF agents to specifically target and treat the underlying pathology, signifying its importance, and possibly accounting for its efficacy. We evaluate the available literature documenting the efficacy of anti-VEGF treatment in DMO. A key clinical finding was that anti-VEGF, as a drug class, achieved superior resolution of macular oedema and visual improvements that were consistently sustainable over 3 years, with some evidence pointing towards 5-year sustainability too. Hence, with intravitreal anti-VEGF treatments increasingly available, better long-term prognosis and, crucially, reduced likelihood of progression to blindness can be expected in patients with DMO.