Abstract
Diabetic macular oedema (DMO) is an important cause of moderate vision loss in people with diabetes. Advances in imaging technology have shown that a significant proportion of patients with DMO respond sub-optimally to existing treatment options. Identifying associations and predictors of response before treatment is initiated may help in explaining visual prognosis to patients and aid the development of personalized treatment strategies. Imaging features, such as central subfoveal thickness, photoreceptor integrity, disorganization of retinal inner layers, choroidal changes, and macular perfusion, have been reported to be prognostic factors of visual acuity (VA) in DMO. In this review we evaluated each risk factor to understand their relative importance in visual prognostication of DMO eyes post-treatment. Although individually, some of these factors may not be significant predictors, in combination they may form phenotypes that can inform visual prognosis. Stratification based on these phenotypes needs to be developed to progress to personalized medicine for DMO.
Highlights
Diabetic macular oedema (DMO) is the most frequent cause of moderate vision loss in people with diabetes
For at least 40 years, patients and ophthalmologists were satisfied with the outcomes of the Early Treatment Diabetic Retinopathy Study (ETDRS) study that showed that the risk of moderate visual loss can be reduced by about 50% in laser treated individuals [2]
Expectations of patients and providers have increased with the availability of anti-VEGF agents as approximately 50% of patients with visual impairment treated with anti-VEGF improve by two lines of visual acuity (VA) on ETDRS visual acuity charts by two years, if treated optimally [3,4]
Summary
Diabetic macular oedema (DMO) is the most frequent cause of moderate vision loss in people with diabetes. For at least 40 years, patients and ophthalmologists were satisfied with the outcomes of the Early Treatment Diabetic Retinopathy Study (ETDRS) study that showed that the risk of moderate visual loss can be reduced by about 50% in laser treated individuals [2]. Intravitreal anti-vascular endothelial growth factor agents (anti-VEGF) have replaced macular laser and intravitreal steroids as the main treatment option for visual impairment due to centre-involving DMO (CI-DMO) [3]. We evaluate the potential risk factors that can be considered in future prognostic models on visual impairment due to DMO, so that management of DMO can be personalised based on risk of visual loss.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
