Recommendations for the appropriate management of diabetic macular edema: Light on DME survey and consensus document by an expert panel

Purpose: The Light on DME survey was designed to address several issues concerning the management of diabetic macular edema (DME) with the objective of producing practical recommendations for the appropriate treatment of this condition. Methods: The recommendations considered aspects of DME treatment that are controversial and insufficiently supported by the evidence and were based on a consensus reached by an expert panel. Consensus was achieved by means of the Delphi method. Thirty-one Italian retinologists were asked to rate the appropriateness of a comprehensive set of scenarios typically encountered in the management of DME in clinical practice. The results of the appropriateness evaluation were analyzed by the study panel and a second assessment round was conducted for those scenarios on which no consensus was reached. Results: Consensus was reached on several relevant aspects of current DME management, namely the initiation and course of treatment with anti-vascular endothelial growth factor (VEGF) therapy, assessment of the outcomes of anti-VEGF therapy based on both functional and morphologic outcomes, combination of anti-VEGF with laser therapy, and management of nonresponders to anti-VEGFs. A few issues, including the definition of DME based on novel diagnostic tools, the need for stable metabolic parameters before initiating anti-VEGF therapy, and the use of a second anti-VEFG after failure of the first anti-VEGF, proved controversial. Conclusions: A clear consensus among DME experts was reached on several relevant aspects of DME management. Based on this consensus, detailed and practical recommendations to guide ophthalmologists in the use of novel approaches to DME could be developed.