title: Medical management for the prevention and treatment of diabetic macular edema.
abstract: Recent clinical trials have changed the management paradigm for diabetic macular edema (DME). There is an urgent need to identify the most effective ways of preventing retinopathy or intervening at an early, asymptomatic stage in order to preserve vision. The rise in the incidence of diabetes is a serious public health concern. Grading and screening programmes help to identify sight threatening diabetic retinopathy in the community early and facilitate timely referral to an ophthalmologist. Systemic therapies for DME target the key modifiable risk factors: metabolic and blood pressure control. There may also be a role for modification of the renin-angiotensin system and for lipid lowering agents. Improved glycemic and blood pressure control remain the most effective ways of reducing morbidity from DME. Fenofibrate also has beneficial effects, but the mechanism for this remains unclear. Multiple new treatments are in the pipeline, and these are expected to change our approach to DME for the first time in 30 years.
authors: Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
authors: Christine A
authors: CA
authors: Kiire
authors: Massimo
authors: M
authors: Porta
authors: Victor
authors: V
authors: Chong
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008269:Macular Edema / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D000960:Hypolipidemic Agents; D045162:Thiazolidinediones
keywords: diabetes; diabetic macular edema; diabetic retinopathy; epidemiology; glitazones; glycosylated hemoglobin; hypertension; lipid lowering agents; metabolic control; renin-angiotensin system