Abstract
Diabetes has been recognized by the World Health Organization (WHO) as a noncommunicable, chronic disease and a 21st century epidemic. Diabetic retinopathy (DR) is one of the three leading causes of blindness among the working-age population aged 20 to 74 years.
 Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and the impact of DME on quality of life is very significant. Currently, first-line treatment recommendations for center-involved DME (CI-DME) include intravitreal anti-VEGF injections on a monthly or bimonthly regimen. It is essential to understand the burden that treatment regimens have on patients, as well as on healthcare systems. The most significant improvement to the regimen would be to have fewer injections and monitoring visits while maintaining satisfactory vision outcomes. A lower number of intravitreal injections could optimize disease outcomes by improving patient compliance.
 This article discusses novel agents targeting alternative pathways and mechanisms involved in the pathogenesis of DME, as well as high-dose drugs and novel approaches to treatment regimens aimed at extending treatment intervals, decreasing treatment burden, and increasing treatment efficacy. This knowledge will enhance the selection of treatments, thereby improving patient compliance with therapy and optimizing healthcare system resources.
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