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Evidence supports laser as current gold standard for diabetic macular edema, speaker says
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KOLOA, Hawaii — Laser therapy is more effective in treatment of diabetic macular edema than is commonly appreciated, according to a speaker here.
 Andrew P. Schachat |
"Better control of underlying diabetes is better [for reducing diabetic retinopathy], and the difference is huge," Andrew P. Schachat, MD, said at Retina 2010.
In the context of ocular manifestations of diabetes, however, the available evidence suggests that laser should be considered the current gold-standard therapy, Dr. Schachat said.
The original ETDRS study published in the early 1980s appeared to show minimal benefit of laser over observation, prompting interest in steroid therapy over the past 2 decades. Laser halved the risk of vision loss, but 3% of patients had greater than three-line vision gain and 17% of patients had any vision gain at 5 years.
However, the ETDRS study enrolled a large percentage of patients with better than 20/40 vision at baseline - patients incapable of gaining three lines of vision, Dr. Schachat said. Among patients with visual acuity worse than 20/40 at baseline, around 40% had three-line vision gain by the study's end, he said.
A significant vision gain with laser has been demonstrated more recently in the DRCR.net trial, which noted 47% of laser therapy recipients having vision gain at 4 years, Dr. Schachat said.
Hawaiian Eye and Retina 2011 will be held January 16-21, 2011 at the Hyatt Regency Maui Resort & Spa in Ka'anapali, Maui. Learn more at OSNHawaiianEye.com.