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Laser Superior to Corticosteroids in Diabetic Macular Edema

BETHESDA, Md -- July 28, 2008 -- A promising new drug therapy used to treat diabetic macular edema proved less effective than traditional laser treatments, according to a study published online in the July 2008 issue of Ophthalmology.

The study demonstrates that laser therapy is not only more effective than corticosteroids in the long-term treatment of diabetic macular edema but also has far fewer side effects.

This is the first study to compare the long-term benefits of treating diabetic macular edema with corticosteroid injections or the traditional laser treatments and to evaluate their potential side effects.

A total of 693 patients with diabetic macular edema participated in the study at 88 sites across the United States. Each person was randomly assigned to corticosteroid or traditional laser treatment.

Following the treatment, investigators tested each patient to determine whether the procedure had prevented substantial vision loss. Investigators defined substantial vision loss as reading at least 2 less lines on a standard eye chart 2 years after entering the study.

In the corticosteroid-treated group, 28% experienced substantial vision loss compared with 19% in the laser-treated group. In addition, about one-third of the eyes treated with laser therapy showed substantial improvement in vision.

"Results of this study should confirm the use of laser treatment for diabetic macular edema and will have a significant impact on quality of life for tens of thousands of people being treated for diabetic macular edema in the United States each year," said Paul A. Sieving, MD, National Eye Institute, Bethesda, Maryland.

In addition, 51% of the patients in the corticosteroid-treated group had cataract surgery compared with only 13% of those in the laser-treated group.

Furthermore, almost half of the patients in the corticosteroid-treated group had increased eye pressure, and one-third needed eye drop medications to lower their eye pressure. Only 8% of patients in the laser-treated group required eye drop medications.

Researchers found that, while not as effective as the laser treatment, corticosteroid treatment did provide some benefit.

"Our findings raise the possibility that combining laser with corticosteroids might produce greater benefit," said Neil Bressler, MD, Diabetic Retinopathy Clinical Research Network and Johns Hopkins University, Baltimore, Maryland.

Only diabetic macular edema was examined as part of this study. Macular edema from conditions other than diabetes may respond to corticosteroid treatment and laser treatment differently.

SOURCE: US National Institutes of Health

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