The EURETINA 2017 diabetic macular edema guidelines changed the game. Speakers at a lunch symposium on Day 2 of EURETINA 2022 believe it might be time to move on.
Day 2 of the 22nd EURETINA Congress (EURETINA 2022) is in the books, and with it another day of the many things presenters, delegates and press look forward to at conferences of this stature. And though your correspondent, in particular, relishes the deliciously soft double chocolate cookies served at sponsored lunch symposia, it is the academic research, the crystal ball into the future of eye medicine, the case studies and the science that ultimately brings the doctors and delegates to the yard.
On this account, EURETINA 2022 delivered once again in unseasonably sunny Hamburg. Beyond delectable chocolatey baked goods, the audience at Day 2’s symposium on Evolving Management in Diabetic Macular Edema were treated to two tasty lectures on the shifting landscape of diabetic macular edema treatment.
Of Timely Treatments and Invaluable Intervention
In 2017, EURETINA made waves when it officially declared the end of an era. Laser photocoagulation was out, and wunderkind anti-VEGF injections were in – and they have remained ever since as the first-line treatment of choice in managing diabetic macular edema (DME).
But five years have passed since then, and the ground is shifting beneath clinicians’ feet once more, according to Dr. Matias Iglicki’s presentation on DME Management: Timely Intervention in Suboptimal Treatment Response.
“DME is a multifactorial disease, and VEGF is not a solo player,” Dr. Ignicki stated. “The original guidelines tell us to check after the third anti-VEGF [injection]. But there are plenty of papers supporting the idea of starting with dex[amethasone] in certain patients.”
Time is the key factor here, according to Dr. Ignicki. He cited research that shows that by and large, if anti-VEGF doesn’t work, it doesn’t work, and this lost time can be costly in terms of the chance to restore lost visual acuity.
The Inflammation Situation
Dr. Ignicki cited inflammation as a key factor in some pathologies of DME, and identifying these cases and treating them with a steroid like dexamethasone in a timely manner is a critical avenue of research. This is where Dr. Dinah Zur picked up the conversation in her talk about Emerging Science in Inflammation: Role in Clinical Care.
Questions abound about whether diabetic retinopathy (DR) and its comorbidities like DME can be called inflammatory diseases, and Dr. Zur noted that inflammation is critical in the progression of DR. She then talked about the power of prognostic and diagnostic biomarkers in choosing the right treatment regimen for management of the disease.
The multifactorality of DR and DME comes into play here. Though VEGF is an important biomarker, it is just one piece of the puzzle. Inflammatory cytokines also play a role, and tracking and managing these biomarkers can provide clinicians with the knowledge needed to provide more tailored and timely treatments to patients.
As new therapies emerge, it is crucial that clinicians begin to think out of the box, Dr. Zur concluded. Looking at OCT scans after pharmacological treatment of DME is critical, but it’s also important to look at out-of-the-box biomarkers like disorganization of retinal inner layers (DRIL).
In the end, the presentations gave way to a lively Q&A on everything from vitrectomy to systemic factor monitoring. But in the end, it is now clear that DME treatment is evolving in exciting ways to deliver more effective, lower burden-of-treatment solutions. Five years after the groundbreaking 2017 EURETINA guidelines, it might be time to take another look at DME treatment regimens.
Editor’s Note: EURETINA 2022 is being held as a hybrid congress in Hamburg, Germany on 1-4 September 2022. Reporting for this story took place at the event.