Diabetic macular edema (DME) is now classified as center-involving (CI-DME) versus non-center-involving. The threshold for initiating anti-VEGF therapy according to DRCR.net Protocol T is:

• A Any DME on OCT regardless of visual acuity
• B CI-DME with retinal thickness >250 microns and VA worse than 20/32
• C DME with hard exudates within 500 microns of the center
• D CI-DME with visual acuity worse than 20/25 ✓

Explanation

Protocol T (DRCR.net) enrolled patients with CI-DME and visual acuity between 20/32 and 20/320, comparing three anti-VEGF agents (ranibizumab, bevacizumab, aflibercept). The key criterion for treatment initiation was center-involving DME with vision impairment (worse than 20/25 per most current guidelines and FDA approvals). Non-center-involving DME with good vision is typically observed. Hard exudates alone without center involvement do not mandate anti-VEGF.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.