As someone affected by diabetes, you know that your vision is precious, but do you know how to protect it?
Here, you’ll learn a lot about diabetic macular edema and anti-VEGF treatments for DME. Empower yourself to take an active role in saving your vision. Use these resources to take part in your care today—for yourself and for your loved ones.
International DME Summit Whitepaper
We invite you to download or print the Angiogenesis Foundation’s PDF Whitepaper on Advocating for Improved Treatment and Outcomes for Diabetic Macular Edema in 2014 by clicking the image above.
Canada DME Summit Whitepaper
We invite you to download or print the Angiogenesis Foundation’s PDF Whitepaper on Advocating for Improved Treatment and Outcomes for Diabetic Macular Edema in Canada by clicking the image above.
US DME Summit Whitepaper
We invite you to download or print the Angiogenesis Foundation’s PDF Whitepaper on the National Multi-Stakeholder Expert Summit on Diabetes and Vision Loss by clicking the image above.
DME Progression and Treatment Infographic
Clinical Trial Resources:
A service of the U.S. National Institutes of Health – ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world.
Information on Diabetes & its Eye Complications:
International Diabetes Foundation
World Health Organization
U.S. NIH National Eye Institute
American Diabetes Association
Diabetes is the primary cause of new incidences of blindness among adults aged 20–74 years.1
Diabetes is a chronic disease that needs consistent management.
Diabetes occurs when the pancreas fails to produce any or enough insulin, or is unable to use the insulin properly. This results in a high level of blood glucose (blood sugar) that needs to be managed in order to prevent other serious conditions, such as vascular complications, organ failure or premature death.2
The International Diabetes Federation (IDF) estimates that 382 million people are living with diabetes worldwide7.
Diabetes can lead to a range of health complications, such as blindness, high blood pressure, kidney disease, neuropathy (nervous system disease), heart disease, stroke, and amputation.3
Blindness can be caused by a number of eye conditions that develop as a complication of diabetes, including cataract, glaucoma, diabetic retinopathy and diabetic macular edema.15
Diabetic retinopathy is the most common diabetic eye disease and the leading cause of blindness among working adults around the world.7
Diabetic retinopathy is a disorder of the retina caused by damage to the retinal blood vessels in patients with type 1 or type 2 diabetes.
Diabetic retinopathy affects approximately 93 million people worldwide as of 2010.20
Global estimates in 2010 found that a third of people with diabetes have signs of diabetic retinopathy.19
Anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy15 and should get a dilated eye exam at least once a year.
Diabetic retinopathy usually affects both eyes.54
Diabetic retinopathy has four stages and treatments will differ by stage.
DME can develop during any of the stages of diabetic retinopathy, though it is most common in the more severe stages.
About half of the people with proliferative retinopathy also have macular edema.15
Diabetic macular edema (DME) is a form of diabetic retinopathy and a leading cause of vision loss in patients with diabetic retinopathy.26, 27
DME is characterized by swelling or thickening of the retina and the leaking of fluid, specifically in the macula,28 a small area in the back of the eye that focuses and sharpens vision.15
Globally, 21 million people are estimated to live with DME.20
Every year, there are 75,000 new cases of DME in the United States alone.28
DME develops without symptoms or causing pain, so it is crucial that diabetes patients get a comprehensive dilated eye exam at least once a year before experiencing any problems with vision.
There are two forms of DME: focal and diffuse. Treatment will differ by form.
Risk of developing DME greatly increases with the duration of diabetes.15, 19
Other major risks for DME include high levels in blood glucose, blood pressure and blood lipids. Keeping these levels as close to normal as possible greatly reduces risk.
If DME is treated early, vision loss can be reversed. In cases where DME has progressed, treatment can stop or slow down vision loss.
Major treatments for DME include focal laser photocoagulation, vitrectomy, corticosteroid therapy and anti-VEGF therapy.
The vascular endothelial growth factor (VEGF) is a glycoprotein that has been found to contribute significantly to the development of diabetic macular edema.
Anti-VEGF therapy has been effective in reducing macular edema and stabilizing or even improving vision without increased risk for side effects.
Let’s raise awareness about this disease, which affects so many lives. Join our supportive online communities, part of our System ENABLE™, and become an advocate for all who are touched by DME.
- DRCR Network releases new data on Anti-VEGF response for diabetic macular edema
- Egypt has become the 31st country to approve aflibercept to treat diabetic retinopathy in patients with DME.
- The Angiogenesis Foundation Launches Nationwide Campaign for Saving Vision on World Sight Day
- People with Diabetes Have More Options: FDA Approves Anti-VEGF Agent Aflibercept for Diabetic Retinopathy
- Ranibizumab Vision Improvement Predicted by Retinal Venular Calibre
- Big news for people with diabetes: Anti-VEGF agent ranibizumab approved to treat diabetic retinopathy to prevent vision loss
- RIDE/RISE Extension Studies Demonstrate Sustained Visual Gains in DME Patients
- Novel Treatment Pathways for DME
- Ranibizumab Treatment 3-Year Outcomes Similar in DME Patients With and Without Vitrectomy
- Small Change, Big Rewards in A1c and Blood Pressure Control for Diabetes Patients
- The Angiogenesis Foundation Convenes the Canadian National Multistakeholder Expert Summit for Diabetic Macular Edema
- Anti-VEGF Agent Ranibizumab Gets FDA Breakthrough Therapy Designation for Diabetic Retinopathy
- Anti-VEGF Agent Aflibercept Approved in Canada for Treating Diabetic Macular Edema (DME)
- FDA Grants Priority Review of Antiangiogenic Agent Aflibercept for Treatment of Diabetic Retinopathy in DME Patients
- Antiangiogenic Agent Aflibercept Approved in Japan for Treatment of Diabetic Macular Edema
- Aflibercept injection shown to be superior to bevacizumab and ranibizumab in visual gains for DME patients
- Fluocinolone acetonide intravitreal implant (Iluvien) Gets FDA Approval for Treating Diabetic Macular Edema (DME)
- Dexamethasone Intravitreal Implant Gets EU Approval for Treatment of Diabetic Macular Edema
- Intravitreal aflibercept for DME improves vision better than laser
- FDA approves biodegradable dexamethasone intravitreal implant for the treatment of diabetic macular edema
- Anti-VEGF agent aflibercept gets EU Approval for Treatment of Diabetic Macular Edema (DME)
- FDA approves anti-VEGF agent aflibercept for treating Diabetic Macular Edema (DME)
- European commission recommends approval of anti-VEGF agent aflibercept for treatment of diabetic macular edema
- Antiangiogenic Agent Ranibizumab Approved in Japan for Treatment of Diabetic Macular Edema
- Diabetes ‘no longer leading cause of blindness’ in the UK
When an excessive amount of blood accumulates and over-stretches the blood vessel or artery, usually caused by damage to or weakness of the wall of the vessel.78
The growth of new capillary blood vessels from existing blood vessels.
Drugs designed to target and interfere with the process of angiogenesis.
A process that interferes with specific pathways associated with a disease in order to halt angiogenesis.
Treatment that controls disease by stopping new abnormal blood vessels from forming.
Treatment designed to reduce function of VEGF, which causes new blood vessels to form.
Medical study with human volunteers to test, assess and compare the safety and efficacy of treatments.
An eye condition when the lens of the eye is clouded so light cannot pass through.79
The use of two or more drugs/therapies to treat a condition more aggressively.
Diabetic Eye Disease
A range of eye problems that develop as a complication of diabetes.15
Diffuse Diabetic Macular Edema
A less common but more severe form of DME24 that involves the center of the macula.32
Abnormal levels of blood lipids (cholesterol and triglycerides42).
An inflammatory condition that affects the interior of the eye, usually caused by infection.81
Cells that line the inner layer of blood vessels.82
Focal Diabetic Macular Edema
The most common form of DME that typically does not involve the center of the macula.32
An eye disease characterized by elevated pressure in the eye that can lead to vision loss.83
HbA1c is a molecule that is formed when hemoglobin, a protein in red blood cells, connects to glucose.37 It is also a lab test that uses your blood sample to measure your average blood glucose level for the past three months based on your HbA1c levels.84 This shows how well you are controlling your diabetes.
- A normal HbA1c level is 5.6% or less, and safe HbA1c levels for diabetes patients usually range between 6.5-7%.84
- Studies have found that every percentage point drop in HbA1c levels can lower the chances of developing microvascular complications (e.g. eye, kidney, and nerve diseases) by 40%.1
Chronic high levels of sugar in the blood.85
Abnormally high levels in blood pressure.86
A condition when body tissue is deprived of oxygen.87
Number of new cases diagnosed each year.2
A hormone that plays a critical role in converting sugars and starches into glucose as a source of energy for the body,10 and stores glucose in cells.11
A specific pressure in the eyeball that maintains the eye’s round shape.88
The small part of the retina that focuses images and lets you see fine details clearly.13
Tiny area of swelling in the blood vessels of the retina15 usually associated with diabetic retinopathy.25, 89
A large gland positioned behind the stomach that produces the hormones insulin and glucagon.90
Total number of existing (including newly diagnosed) cases for each year.2
The tissue at the back of the eye17 that receives what you see and sends signals to your brain.
Any factor that affects your chance of getting a disease.
Vascular endothelial growth factor
Protein that causes vascular permeability and new, abnormal blood vessels to form through the process of angiogenesis.
The capacity of small molecules and whole cells to pass through the vessel wall.92
The sharpness or clarity of vision at a distance.31
A gel-like substance that consists of millions of intertwined fine fibers that are attached to the surface of the retina. This substance supports the eye’s round shape. The vitreous gradually shrinks as a natural process of aging and may separate from the retina, resulting in vitreous detachment.93
A condition when the vitreous attaches to the retina.
2. Centers for Disease Control and Prevention. Diabetes Report Card 2012. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012. Accessed June 3, 2013, http://www.cdc.gov/diabetes/pubs/pdf/DiabetesReportCard.pdf.
3. “Diabetes Basics: Diabetes Statistics.” American Diabetes Association. Accessed June 3, 2013, http://www.diabetes.org/diabetes-basics/diabetes-statistics/.
4. “Morbidity and Mortality Weekly Report: Increasing Prevalence of Diagnosed Diabetes – United States and Puerto Rico, 1995-2010.” Centers for Disease Control and Prevention. Accessed June 3, 2013, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a4.htm.
5. Boyle JP, Thompson TJ, Gregg EW, et al. Projection of the year 2050 burden of diabetes in the U.S. adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29. Accessed June 4, 2013 http://www.pophealthmetrics.com/content/8/1/29.
6. Wenick AS, Bressler NM. Diabetic Macular Edema: Current and Emerging Therapies. Middle East Afr J Ophthalmol. 2012 Jan-Mar;19(1): 4–12. Accessed June 12, 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277023/.
7. Guariguata L, Nolan T, Beagley J, et al. (2013) IDF Diabetes Atlas, Sixth Edition. International Diabetes Federation: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf
8. “Diabetes Public Health Resource: CDC Identifies Diabetes Belt.” Centers for Disease Control and Prevention. Accessed June 5, 2013, http://www.cdc.gov/diabetes/pdfs/data/diabetesbelt.pdf.
9. Gordon, Serena. “Southeastern States Mired in the ‘Diabetes Belt’: CDC Report.” U.S. News.com. March 8, 2011, http://health.usnews.com/health-news/diet-fitness/diabetes/articles/2011/03/08/southeastern-states-mired-in-the-diabetes-belt-cdc-report.
10. “Diabetes Basics: Type 1.” American Diabetes Association. Accessed June 20, 2013, http://www.diabetes.org/diabetes-basics/type-1/.
11. “Diabetes Basics: Type 2.” American Diabetes Association. Accessed June 20, 2013, http://www.diabetes.org/diabetes-basics/type-2/.
12. “Living With Diabetes: Insulin Basics.” American Diabetes Association. Last edited June 28, 2013, http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-basics.html.
13. “Living With Diabetes: Eye Complications.” American Diabetes Association. Last edited July 15, 2013, http://www.diabetes.org/living-with-diabetes/complications/eye-complications/.
14. Stewart, MR. Critical appraisal of ranibizumab in the treatment of diabetic macular edema. Clinical Ophthalmology. 2013(7):1257–1267.
15. “Facts About Diabetic Retinopathy.” National Eye Institute, National Institutes of Health. Last edited: June 2012, http://www.nei.nih.gov/health/diabetic/retinopathy.asp.
16. American Diabetes Association. Standards of Medical Care in Diabetes—2010. Diabetes Care. 2010;33(1):S11-S61. Accessed June 2013, http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.
17. “Leading Causes of Blindness in the U.S.” National Eye Institute, National Institutes of Health. Accessed June 2013, http://www.nei.nih.gov/health/fact_sheet.asp.
18. Klein, R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995;18(2):258– 268. Accessed June 2013, http://care.diabetesjournals.org/content/18/2/258.
19. Ding J, Wong TY. Current epidemiology of diabetic retinopathy and diabetic macular edema. Curr Diab Rep. 2012 Aug;12(4):346-54. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/22585044.
20. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556-64. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/22301125.
21. “Vision Problems in the U.S.: Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America. Preventblindness.org. Prevent Blindness America. Accessed June 2013, http://www.visionproblemsus.org/diabetic-retinopathy.html.
22. Kempen JH, O’Colmain BJ, Leske MC. The prevalence of diabetic retinopathy among adults in the United States. Archives of Ophthalmology. 2004;122(4):552-563. Accessed June 2013, http://europepmc.org/abstract/MED/15078674.
23. Stewart MW. The Expanding Role of Vascular Endothelial Growth Factor Inhibitors in Ophthalmology. Mayo Clinic Proceedings. 2012;87(1):77-88.
24. Lopes de Faria JM, Jalkh AE, Trempe CL, et al. Diabetic macular edema: risk factors and concomitants. Acta Ophthalmol. Scand. 1999;77:170–175. Accessed June 2013, http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0420.1999.770211.x/pdf.
25. Wiley H, Ferris FL III. Nonproliferative Diabetic Retinopathy and Diabetic Macular Edema. Retinal Vascular Disease. Section 2, Chapter 47:940-967.
26. Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE Study. Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema. Ophthalmology. 2011;118(4):615-625.
27. Ciulla TA, Amador AG, Zinman B. Diabetic Retinopathy and Diabetic Macular Edema Pathophysiology, screening, and novel therapies. Diabetes Care. 2003 Sept;26(9):2653-2664. Accessed June 2013, http://care.diabetesjournals.org/content/26/9/2653.abstract.
28. Bhagat N, Grigorian RA, Tutela A, et al. Diabetic Macular Edema: Pathogenesis and Treatment. Survey of Ophthalmology. 2009;54(1):1-32.
29. Kulkarni AD, Michael SI. Diabetic Macular Edema: Therapeutic Options. Diabetes Ther. 2012 December;3(1):2. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508119/.
30. Moss SE, Klein R, Klein BE. Ten-year incidence of visual loss in a diabetic population. Ophthalmology. 1994 Jun;101(6):1061-70. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/8008348.
31. “Visual Acuity: What is 20/20 Vision?” aoa.org. American Optometric Association. Accessed June 2013, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/visual-acuity.
32. Browning DJ, Altaweel MM, Bressler NM, et al. Diabetic Macular Edema: What is Focal and What is Diffuse? Am J Ophthalmol. 2008 November;146(5):649–655. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785449/.
33. Nguyen QD, Tatlipinar S, Shah SM, et al. Vascular Endothelial Growth Factor Is A Critical Stimulus for Diabetic Macular Edema. Am J Ophthalmol. 2006;142:961-969.
34. Bresnick GH. Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology. 1983 Nov;90(11):1301-17. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/6664669?dopt=Abstract.
35. Nidhi Talwa. Association for Research in Vision and Ophthalmology (ARVO) 2013 Annual Meeting: Abstract 1540 – C0030. Presented May 6, 2013.
36. Bloomgarden, ZT. Screening for and managing diabetic retinopathy: Current approaches. American Journal of Health-System Pharmacy. 2007 Sept;64(17):S8-S14. Accessed June 2013, http://www.ajhp.org/content/64/17_Supplement_12/S8.abstract.
37. “Living With Diabetes: A1C and eAG.” American Diabetes Association. Accessed July 17, 2013, http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/.
38. Diep TM, Tsui, I. Risk factors associated with diabetic macular edema. Diabetes Research and Clinical Practice. 2013 June;100(3):298-305. Accessed June 2013, http://www.sciencedirect.com/science/article/pii/S0168822713000120.
39. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329: 977– 986. Accessed June 2013, http://www.nejm.org/doi/full/10.1056/NEJM199309303291401.
40. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854– 865. Accessed June 2013, http://www.sciencedirect.com/science/article/pii/S0140673698070378
41. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837– 853. Accessed June 2013, http://www.sciencedirect.com/science/article/pii/S0140673698070196.
42. “Your Blood Lipids.” Diabetes Education Online. The Regents of the University of California. Accessed June 2013, http://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-fats-oils/your-blood-lipids/.
43. Miljanovic B, Glynn RJ, Nathan DM, et al. A Prospective Study of Serum Lipids and Risk of Diabetic Macular Edema in Type 1 Diabetes. Diabetes. 2004;53(11):2883-2892. Accessed June 2013, http://diabetes.diabetesjournals.org/content/53/11/2883.long.
44. Leske MC, Wu SY, Hennis A, et al. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology. 2005;112:799–805. Accessed June 2013, http://www.sciencedirect.com/science/article/pii/S0161642005000953.
45. Lopes de Faria JM, Jalkh AE, Tremple CL, et al. Diabetic macular edema: risk factors and concomitants. Acta Ophthalmol Scand. 1999 Apr;77(2):170-5. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/10321533.
46. Estacio RO, McFarling E, Biggerstaff S, et al. Overt albuminuria predicts diabetic retinopathy in Hispanics with NIDDM. Am J Kidney Dis. 1998;31:947– 953. Accessed June 2013, http://www.sciencedirect.com/science/article/pii/S0161642005000953.
47. “Living With Diabetes: African Americans and Complications.” American Diabetes Association. Accessed June 2013, http://www.diabetes.org/living-with-diabetes/complications/african-americans-and-complications.html.
48. “Información en Español.” American Diabetes Association. Accessed June 2013, http://www.diabetes.org/espanol/.
49. Dabelea D, Bell RA, D’Agostino RB Jr, et al. Incidence of diabetes in youth in the United States. JAMA 2007;297(24):2716– 2724. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/17595272.
50. “What causes macular edema?” EyeSmart. American Academy of Ophthalmology. Accessed June 2013, http://www.geteyesmart.org/eyesmart/diseases/macular-edema-cause.cfm.
51. “Diabetic Retinopathy.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Accessed June 2013, http://www.mayoclinic.org/medicalprofs/diabetic-retinopathy-2010.html.
52. Fong DS, Aiello LP, Ferris FL III, et al. Diabetic retinopathy. Diabetes Care. 2004;27(10):2540–2553. Accessed June 2013, http://care.diabetesjournals.org/content/27/10/2540.full?ijkey=6b8c1f8c794a20347a79cbb03059e3553fc95c77&keytype2=tf_ipsecsha.
53. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000;23(8):1084–1091. Accessed June 2013, http://care.diabetesjournals.org/content/23/8/1084.abstract?ijkey=12824a75ec6275892b28ee943588baacd4a05003&keytype2=tf_ipsecsha.
54. “Common Eye Disorders.” Centers for Disease Control and Prevention. Accessed June 2013, http://www.cdc.gov/visionhealth/basic_information/eye_disorders.htm.
55. “Macular Edema Symptoms” EyeSmart. American Academy of Ophthalmology. Accessed June 2013, http://www.geteyesmart.org/eyesmart/diseases/macular-edema-symptoms.cfm.
56. “Living with Diabetes: Complications.” American Diabetes Association. Accessed June 20, 2013, http://www.diabetes.org/living-with-diabetes/complications/.
57. Miljanovic B, Glynn RJ, Nathan DM, et al. Serum cholesterol-DCCT/EDIC Study. Diabetes. 2004. Nov;53(11):2883-92. Association for Research in Vision and Ophthalmology (ARVO) 2013 Annual Meeting. Presented May 2013.
58. “Macular Edema Diagnosis.” EyeSmart. American Academy of Ophthalmology. Accessed June 2013, http://www.geteyesmart.org/eyesmart/diseases/macular-edema-diagnosis.cfm.
59. Costa PZ, Soares R. Neovascularization in diabetes and its complications. Unraveling the angiogenic paradox. Life Sciences. 2013;92:1037–1045.
60. Bates Do, Harper SJ. Regulation of vascular permeability by vascular endothelial growth factors. Vascul Pharmcol. 2002 Nov;39(4-5):225-37. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/12747962.
61. Javey G, Schwartz SG, Flynn HW Jr. Emerging Pharmacotherapies for Diabetic Macular Edema. Experimental Diabetes Research. 2011;2012(Article ID 548732):12 pages. Accessed June 2013, http://www.hindawi.com/journals/jdr/2012/548732/.
62. Bandello F, Cunha-Vaz J, Chong NV, et al. New approaches for the treatment of diabetic macular oedema: recommendations by an expert panel. Eye. 2012;26:485-493.
63. Ryan, GJ. New pharmacologic approaches to treating diabetic retinopathy. American Journal of Health-System Pharmacy. 2007;64(17):S15-S21. Accessed June 2013, http://www.ajhp.org/content/64/17_Supplement_12/S15.abstract.
64. Zur D, Loewenstein. Combination Therapy for Diabetic Macular Edema. Journal of Ophthalmology. 2011;2012(Article ID 484612):6 pages. Accessed June 2013, http://www.hindawi.com/journals/jop/2012/484612/.
65. Grover D, Li TJ, Chong CC. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005656. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/18254088.
66. Ranchod TM, Fine SL. Primary treatment of diabetic macular edema. Clin Interv Aging. 2009;4:101-107. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685231/.
67. “High Eye Pressure and Glaucoma.” Glaucoma Research Foundation. Accessed June 2013, http://www.glaucoma.org/gleams/high-eye-pressure-and-glaucoma.php.
68. “Retinal Diseases.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Accessed June 2013, http://www.mayoclinic.org/retinal-diseases/treatment.html.
69. Do DV, Nguyen QD, Khwaja AA, et al. Ranibizumab for Edema of the Macula in Diabetes Study. 3-Year Outcomes and the Need for Prolonged Frequent Treatment. JAMA OPHTHALMOL. 2013;131(2):139-145.
70. Nguyen QD, Shah SM, Heier JS. Primary End Point (Six Months) Results of the Ranibizumab for Edema of the macula in diabetes (READ-2) study. Ophthalmology. 2009 Nov;116(11):2175-81.e1. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/19700194.
71. “Evaluating and Integrating New Evidence in the Treatment of Diabetic Macular Edema.” Retina Today. Bryn Mawr Communications, LLC. Accessed June 2013, http://retinatoday.com/2011/01/supplement/evaluating-and-integrating-new-evidence-in-the-treatment-of-diabetic-macular-edema/.
72. Ford JA, Lois N, Royle P, et al. Current treatments in diabetic macular oedema: systematic review and meta-analysis. BMJ Open. 2013;3:e002269. doi:10.1136/bmjopen-2012- 002269.
73. Nguyen QD, Shah SM, Khwaja AA, et al. Two-year outcomes of ranibizumab for edema of the macular in diabetes (READ-2) study. Ophthalmology. 2010;117:2146-51. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/20855114.
74. Damian McNamara. “Predictors of Diabetic Macular Edema Identified.” Medscape. WebMD, LLC. May 14, 2013. Accessed June 2013, http://www.medscape.com/viewarticle/804171.
75. Simó R, Hernández C. Advances in the Medical Treatment of Diabetic Retinopathy. Diabetes Care. 2009 August;32(8):1556-1562. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713619/.
76. “Press Room: American Diabetes Association Releases New Research Estimating Annual Cost of Diabetes at $245 billion.” American Diabetes Association. March 6, 2013. Accessed June 25, 2013, http://www.diabetes.org/for-media/2013/annual-costs-of-diabetes-2013.html.
77. “Diabetic Retinopathy: Overview.” FamilyDoctor.org. American Academy of Family Physicians. Accessed June 25, 2013, http://familydoctor.org/familydoctor/en/diseases-conditions/diabetic-retinopathy.html.
78. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/aneurysm.
79. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Cataract.
80. Treating eye diseases with anti-VEGF therapies may have side effects. The Association for Research in Vision and Ophthalmology Jan 10, 2013. Accessed June 2013, http://www.arvo.org/About_ARVO/Press_Room/Treating_eye_diseases_with_anti-VEGF_therapies_may_have_side_effects/.
81. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Endophthalmitis.
82. “Endothelial cells.” Biology-online.org. Accessed June 2013, http://www.biology-online.org/dictionary/Endothelial_cells
83. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Glaucoma.
84. “HbA1c.” MedlinePlus. U.S. National Library of Medicine. Accessed June 2013, http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm.
85. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/hyperglycemia.
86. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Hypertension.
87. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/hypoxia.
88. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Intraocular%20Pressure.
89. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Microaneurysm.
90. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Pancreas.
91. “Medical Dictionary.” MedlinePlus. Merriam Webster, Inc. Accessed June 2013, http://www.merriam-webster.com/medlineplus/Prediabetes.
92. “Vascular permeability.” Biology-online.org. Accessed June 2013, http://www.biology-online.org/dictionary/Vascular_permeability.
93. “Facts about Vitreous Detachment.” National Eye Institute, National Institutes of Health. Accessed June 10, 2013, http://www.nei.nih.gov/health/vitreous/vitreous.asp#1.
94. “Living With Diabetes: Asian Americans, Native Hawaiians and Pacific Islanders.” American Diabetes Association. Accessed June 2013, http://www.diabetes.org/living-with-diabetes/complications/asian-american-native.html.
95. Stewart MW. Corticosteroid use for diabetic macular edema: old fad or new trend? Curr Diab Rep. 2012 Aug;12(4):364-75. Accessed June 2013, http://www.ncbi.nlm.nih.gov/pubmed/22581206.
96. “Visual impairment and blindness. Fact Sheet N°282.” World Health Organization. June 2012. Accessed Aug 5, 2013, http://www.who.int/mediacentre/factsheets/fs282/en/index.html.
97. International Diabetes Federation Europe. Diabetes & blindness due to DME. Accessed Aug 5, 2013, http://www.idf.org/sites/default/files/IDF%2520Toolkit_Backgrounder_FINAL.pdf.
98. Nguyen QD, Brown DM, Marcus DM et al. Ranibizumab for Diabetic Macular Edema: Results from 2 Phase III Randomized Trials: RISE and RIDE Ophthalmology. April 2012;119(4):789-801.
99. “DME.” Lucentis. Genentech USA, Inc., n.d. Web. Accessed Sept 6, 2013. < http://www.lucentis.com/hcp/dme/dme-home.html>.
100. Do DV, Nguyen QD, Boyer D et al. One-year outcomes of the DA VINCI Study of VEGF Trap-Eye in Eyes with Diabetic Macular Edema. Ophthalmology. Aug 2012;119(8):1658-65.
101. Regeneron and Bayer Report Positive One-Year Results from Two Phase 3 Trials of EYLEA® (aflibercept) Injection for the Treatment of Diabetic Macular Edema [press release]. Web. Accessed Sept 6, 2013. <http://newsroom.regeneron.com/releasedetail.cfm?ReleaseID=782911. Accessed September 6, 2013>.
102. Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE Study Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema. Ophthalmology. 2011;118(4):615–625.
103. Lang GE, Berta A, Eldem BM, et al. Two-Year Safety and Efficacy of Ranibizumab 0.5 mg in Diabetic Macular Edema Interim Analysis of the RESTORE Extension Study. Ophthalmology. 2013 May 29. pii: S0161-6420(13)00153-X. doi: 10.1016/j.ophtha.2013.02.019. [Epub ahead of print]
113. Novartis gains new indication for Lucentis® in EU for vision loss due to Diabetic Macular Edema, a leading cause of blindness. Reuters. Jan 7, 2011. [Press Release] Accessed Aug 18, 2014: http://www.reuters.com/article/2011/01/07/idUS48855+07-Jan-2011+HUG20110107.
114. EYLEA® (aflibercept) Injection Receives EU Approval for the Treatment of Diabetic Macular Edema (DME). Regeneron Pharmaceuticals, Inc. Aug 11, 2014. [Press Release] Accessed August 18, 2014: http://investor.regeneron.com/releaseDetail.cfm?ReleaseID=865393.
115. EYLEA® (aflibercept) Injection Receives FDA Approval for the Treatment of Diabetic Macular Edema (DME). Regeneron Pharmaceuticals, Inc. July 29, 2014. [Press Release] Accessed August 18, 2014: http://newsroom.regeneron.com/releasedetail.cfm?ReleaseID=862822.
116. Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal Aflibercept for Diabetic Macular Edema. Ophthalmology. 2014.
117. Ozurdex prescribing information. Allergan. Accessed Sept 4, 2014: http://www.allergan.com/assets/pdf/ozurdex_pi.pdf.
118. Allergan Announces OZURDEX® (dexamethasone 700 mcg intravitreal implant in applicator) Now Approved in the European Union for the Treatment of Diabetic Macular Edema. Marketwatch. [Press Release] Accessed Sept 4, 2014: http://www.marketwatch.com/story/allergan-announces-ozurdex-dexamethasone-700-mcg-intravitreal-implant-in-applicatornow-approved-in-the-european-union-for-the-treatment-of-diabetic-macular-edema-2014-09-02.
119. Ozurdex prescribing information. Allergan. Accessed Sept 4, 2014: http://www.allergan.com/assets/pdf/ozurdex_pi.pdf.
120. Ozurdex prescribing information. Allergan. Accessed Sept 4, 2014: http://www.allergan.com/assets/pdf/ozurdex_pi.pdf.
121. Ozurdex prescribing information. Allergan. Accessed Sept 4, 2014: http://www.allergan.com/assets/pdf/ozurdex_pi.pdf.
122. ILUVIEN® for Diabetic Macular Edema (DME). Alimera Sciences. Accessed Sept 5, 2014: http://www.alimerasciences.com/products/iluvien.aspx.
123. PRODUCTS / ILUVIEN™. Psivida. Accessed Sept 5, 2014: http://www.psivida.com/products-iluvien.html.
124. ILUVIEN® for Diabetic Macular Edema (DME). Alimera Sciences. Accessed Sept 5, 2014: http://www.alimerasciences.com/products/iluvien.aspx.
125. Cabrera M, Yeh S, Albini TA. Sustained-Release Corticosteroid Options. J Ophthalmol. 2014;2014:164692. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130028/.
126. Alimera Sciences’ ILUVIEN® Receives Tenth National Marketing Authorization For The Treatment Of Chronic Diabetic Macular Edema. CNN. Sept 3, 2014. [Press Release] Accessed Sept 5, 2014: http://money.cnn.com/news/newsfeeds/articles/prnewswire/CL02802.htm
127. ILUVIEN® for Diabetic Macular Edema (DME). Alimera Sciences. Accessed Sept 29, 2014: http://www.alimerasciences.com/products/iluvien-for-diabetic-macular-edema-dme/