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Watchful waiting is safe for a common cause of vision loss

Illustration. A white eye within a yellow circle on a pink background.

May 20, 2019—Diabetes can steal sight. That's why regular eye exams are a key part of managing the disease.

For people in the U.S. with diabetic eye disease, macular edema is the most common cause of vision loss. In this condition, fluid builds up in a part of the eye that is important for sharp sight. This can cause blurry, distorted vision.

Now a new study sheds light on how best to manage this eye disease before it causes vision loss. It found that, in most cases, there's no advantage to early treatment in people who still see well. Closely monitoring the condition's progress can be just as effective, as long as treatment starts quickly once vision worsens.

A closer look

The study included over 700 people with diabetic macular edema who had 20/25 vision or better. That's normal or near-normal vision. They were randomly assigned to receive either:

  • Eye injections with the medicine aflibercept (known as Eylea). This is a standard treatment for diabetic macular edema.
  • Laser therapy. This is also widely used.
  • Watchful waiting to detect vision changes.

During the study, some people in the laser therapy and watchful waiting groups were given injections once their vision began to worsen.

At the study's end, there was little difference in vision loss among the three groups. And most participants had the same sharp vision they started with: an average of 20/20.

Crucial guidance

Just one aflibercept injection has an average Medicare cost of $1,850. And injections carry a small risk of eye infection.

As a result, doctors and patients often wrestle with this dilemma: Start a costly treatment too soon? Or risk permanent vision loss by getting it too late?

These findings provide sorely needed guidance, the researchers said. Before vision loss has started, it's probably safe to wait and see.

The study appeared in JAMA.

If you have diabetes, ask your doctor how often you should have a comprehensive eye exam.

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