Evolution of controlling diabetic retinopathy: Changing trends in the management of diabetic macular EDEMA at a single institution over the past decade

Purpose: To report the evolution of treatment in managing diabetic macular edema (DME) in a "real world" clinical setting. Methods: Retrospective observational case series of 1,862 patients treated for DME over the last decade. Change in selection of treatment modalities used for controlling DME, visual acuity, and degree of DME on optical coherence tomography were recorded. Results: Over the past decade, there was a linear decrease in laser use, with exponential growth in the utilization of intravitreal injections. An increase in the frequency of clinic visits from 3 ± 2 visits per year to 9 ± 2 visits per year with significant visual and anatomical improvements was noted: mean improvement in visual acuity increased from 0.01 ± 0.1 logMAR units (which is equivalent to less than 1 Snellen line) to 0.3 ± 0.2 logMAR units (which is equivalent to 2 Snellen lines) (P < 0.05), mean decrease in retinal thickness changed from 58 ± 59 m to 162 ± 91 m (P < 0.05). Conclusion: An evolution in treatment strategy for controlling DME over the last decade was reflected by the replacement of focal laser therapy with intravitreal injections. This has produced significant improvements in visual and anatomical outcomes but has increased the frequency of office visits.