Optimizing management of diabetic macular edema in Hong Kong: a collaborative position paper

Neil Bressler, Carmen KM Chan, Ian Y Wong, Marten Brelen, Wai-Man Chan, Chi-Kin Ho, David Liu, Timothy YY Lai

Abstract


Focal/grid laser photocoagulation therapy has been the mainstay of treatment for diabetic macular edema at least since the 1980s, but the standard of care has changed with the advent of agents that target vascular endothelial growth factor. It is widely agreed that anti–vascular endothelial growth factor agents are the preferred first- line option for patients with fovea-involving diabetic macular edema who are able to access anti–vascular endothelial growth factor therapy. However, dosing protocols for anti–vascular endothelial growth factor agents vary and may not be well understood, including when to consider adding or switching to alternative therapies, such as photocoagulation or corticosteroid treatment. In light of such recently changing treatment approaches, a panel of local retinal specialists and an international expert convened to evaluate the roles of anti–vascular endothelial growth factor agents, corticosteroids and laser therapy in the treatment of diabetic macular edema and to formulate a set of recommendations that aim to optimize diabetic macular edema management in Hong Kong. This document summarizes the panel’s recommendations. The key recommendation for the treatment of diabetic macular edema that involves the fovea is that physicians consider adopting an early intensive anti–vascular endothelial growth factor dosing schedule followed by a deferred injection strategy for stability (either resolution of diabetic macular edema or stable diabetic macular edema no longer improving or worsening) after the first 6 months. This protocol has been shown to reduce long-term treatment burden in terms of the number of injections and clinical visits required, while maintaining, on average, excellent outcomes. However, the panel acknowledges that physicians need to consider cost and accessibility restrictions applicable to each patient and to adjust their treatment strategy accordingly.


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