The Future of Treatment for Diabetic Macular Edema

Nancy Holekamp, MD: Dr Leng, what do you see for the future directions in treatments for patients with diabetic macular edema [DME]?

Theodore Leng, MD, FACS: Going back to a point made earlier about at-home monitoring, healthcare is becoming more distributed and more personalized in the patients’ homes, and care is going to meet the patients where they are eventually. Whether that’s going to a health center at a local pharmacy, or another retail chain and having monitoring done, or having the device on their tabletop and in their own homes where they have daily assessments to see if there is a need to treat based on visual acuity changes, that are based on structural changes on OCT [optical coherence tomography] devices. The durability question is an important one because patients can’t be expected to come in monthly forever, or even for the first year, as we’ve seen in real-world studies where the average number of treatments is 3 to 4, and we have optimal outcomes compared to the clinical trials. At this year’s American Society [American Society of Retina Specialists Annual Scientific Meeting], retina specialists met in San Antonio, Texas, in one of my sessions one of the colleagues presented a data analysis looking at their patients at their center and what percent of patients would qualify for a clinical trial. They found that 50% of the patients in their center met the inclusion and exclusion criteria for a clinical trial. That tells us that half of the patients that we see every day don’t meet entry criteria for these trials that we’re basing these results in our treatment modalities on. There is an unmet need in that half of the patients out there won’t be able to enter, and therefore shouldn’t be expected to have trial outcomes. What are we supposed to do for those patients? There are many different areas where there’s an innovation that’s needed. Fortunately, as a field, both on the physician side and the industry side, there’s many innovative people and new ideas being brought to the forefront. The gene therapies that they work on could potentially be lifelong treatments and essentially be a cure for many retinal vascular diseases. That’s an exciting area to focus on. This implant that Dr Rahimy mentioned earlier, the port delivery, has the potential to become a platform technology with which we could administer multiple different agents over time and be able to give combination therapy through this device. The future is bright and our patients will ultimately benefit from the innovation that’s going on in this field, whether that’s in our offices or in their homes.

Nancy Holekamp, MD: Thanks to all of you for this rich and informative discussion, and thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

Transcript edited for clarity.