Consensuses and controversies on causes, diagnosis and management of diabetic macular edema (DME)

Danny S C Ng¹, Paisan Ruamviboonsuk², Rajendra S Apte³, Sanyam Bajimaya⁴, Carmen K M Chan⁵, Andrew Chang⁶, Carol Y Cheung⁷, Shih-Jen Chen⁸, Varun Chaudhary⁹, Voraporn Chaikitmongkol¹⁰, Jay Chhablani¹¹, Taraprasad Das¹², Suber S Huang¹³, Jost B Jonas¹⁴, Timothy Y Y Lai⁷, Chi-Chun Lai¹⁵, Jin Ma¹⁶, Marion R Munk¹⁷, Raja Narayanan¹⁸, Nishant V Radke¹⁹, Min Sagong²⁰, Charumathi Sabanayagam²¹, Sobha Sivaprasad²², Masahiko Shimura²³, Koh-Hei Sonoda²⁴, Jennifer K Sun²⁵, Gavin S W Tan²¹, Brijesh Takkar²⁶, Gianni Virgili²⁷, Stela Vujosevic²⁸, Min Wang²⁹, Seung-Young Yu³⁰, Xinyuan Zhang³¹, Jingfa Zhang¹⁹, Tien-Yin Wong³², Dennis S C Lam³³

Affiliations

¹ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
² Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand.
³ Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US; Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US; Department of Developmental Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US.
⁴ Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
⁵ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Eye Hospital, Hong Kong, China.
⁶ Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia.
⁷ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
⁸ Department of Ophthalmology, Taipei Veterans General Hospital, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁹ Department of Surgery, Hamilton Regional Eye Institute, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
¹¹ Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, US.
¹² LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Shantilal Shanghvi Eye Institute, Mumbai, India.
¹³ Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Retina Center of Ohio, Cleveland, OH, US; Bascom Palmer Eye Institute, University of Miami, Coral Gables, FL, US.
¹⁴ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France; Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany; Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
¹⁵ Department of Ophthalmology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁶ State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
¹⁷ Department of Ophthalmology, Bern University Hospital, University of Bern, Bern, Switzerland; Gutblick Practise Group, Pfäffikon, Switzerland; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, US.
¹⁸ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Indian Health Outcomes, Public Health and Economics Research Center (IHOPE), LV Prasad Eye Institute, Hyderabad, India.
¹⁹ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China; Eye Department, C+ Health CKJ (Shenzhen) Hospital, Luohu, Shenzhen, China.
²⁰ Department of Ophthalmology, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, Korea.
²¹ Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
²² Institute of Ophthalmology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK.
²³ Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
²⁴ Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
²⁵ Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, US; Department of Ophthalmology, Harvard Medical School, Boston, MA, US.
²⁶ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India.
²⁷ Eye Clinic, Department of Neuromuscular Diseases and Sense Organs, Careggi University Hospital, Florence, Italy; Department of Neuroscience, Psychology, Pharmacology and Pediatrics (Neurofarba), University of Florence, Florence, Italy; IRCCS-Fondazione Bietti, Rome, Italy.
²⁸ Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
²⁹ Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
³⁰ Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
³¹ Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing Tongren Hospital, Beijing, China.
³² Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, Tsinghua Medicine, Tsinghua University, Beijing, China; School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China; Beijing Key Laboratory of Intelligent Diagnostic Technology and Devices for Major Blinding Eye Diseases, Tsinghua Medicine, Tsinghua University, Beijing, China. Electronic address: wongtienyin@tsinghua.edu.cn.
³³ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China; Eye Department, C+ Health CKJ (Shenzhen) Hospital, Luohu, Shenzhen, China; The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China. Electronic address: dennislam@pieri.cuhksz.org.

PMID: 41005472
DOI: 10.1016/j.preteyeres.2025.101406

Review

Consensuses and controversies on causes, diagnosis and management of diabetic macular edema (DME)

Danny S C Ng et al. Prog Retin Eye Res. 2025.

. 2025 Sep 24:101406.

doi: 10.1016/j.preteyeres.2025.101406. Online ahead of print.

Authors

Affiliations

¹ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
² Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand.
³ Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US; Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US; Department of Developmental Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, US.
⁴ Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
⁵ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Eye Hospital, Hong Kong, China.
⁶ Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia.
⁷ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
⁸ Department of Ophthalmology, Taipei Veterans General Hospital, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁹ Department of Surgery, Hamilton Regional Eye Institute, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
¹¹ Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, US.
¹² LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Shantilal Shanghvi Eye Institute, Mumbai, India.
¹³ Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Retina Center of Ohio, Cleveland, OH, US; Bascom Palmer Eye Institute, University of Miami, Coral Gables, FL, US.
¹⁴ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France; Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany; Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
¹⁵ Department of Ophthalmology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁶ State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
¹⁷ Department of Ophthalmology, Bern University Hospital, University of Bern, Bern, Switzerland; Gutblick Practise Group, Pfäffikon, Switzerland; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, US.
¹⁸ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India; Indian Health Outcomes, Public Health and Economics Research Center (IHOPE), LV Prasad Eye Institute, Hyderabad, India.
¹⁹ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China; Eye Department, C+ Health CKJ (Shenzhen) Hospital, Luohu, Shenzhen, China.
²⁰ Department of Ophthalmology, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, Korea.
²¹ Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
²² Institute of Ophthalmology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust, London, UK.
²³ Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
²⁴ Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
²⁵ Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, US; Department of Ophthalmology, Harvard Medical School, Boston, MA, US.
²⁶ LV Prasad Eye Institute, Kalam Anji Reddy Campus, Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad, India.
²⁷ Eye Clinic, Department of Neuromuscular Diseases and Sense Organs, Careggi University Hospital, Florence, Italy; Department of Neuroscience, Psychology, Pharmacology and Pediatrics (Neurofarba), University of Florence, Florence, Italy; IRCCS-Fondazione Bietti, Rome, Italy.
²⁸ Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
²⁹ Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
³⁰ Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
³¹ Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing Tongren Hospital, Beijing, China.
³² Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, Tsinghua Medicine, Tsinghua University, Beijing, China; School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China; Beijing Key Laboratory of Intelligent Diagnostic Technology and Devices for Major Blinding Eye Diseases, Tsinghua Medicine, Tsinghua University, Beijing, China. Electronic address: wongtienyin@tsinghua.edu.cn.
³³ The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China; Eye Department, C+ Health CKJ (Shenzhen) Hospital, Luohu, Shenzhen, China; The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China. Electronic address: dennislam@pieri.cuhksz.org.

PMID: 41005472
DOI: 10.1016/j.preteyeres.2025.101406

Abstract

Diabetic macular edema (DME) is the most common cause of vision-threatening diabetic retinopathy (VTDR) with an increasing prevalence tied to the global epidemic in diabetes. Despite significant advances, the management of DME remains a dynamic field with many unresolved controversies. Optical coherence tomography (OCT) allows objective assessment, however, correlation between vision and morphological changes can be inconsistent, causing disagreements on treatment strategies. DME is a complex disease with multifactorial pathophysiological pathways, leading to heterogenous treatment responses. There is a lack of standardized definition of treatment 'non-response" and protocol for switching to second-line or adjuvant treatments. New anti-vascular endothelial growth factor (anti-VEGF) drugs and multi-targeted therapies seem to demonstrate improved durability, but long-term data is not yet available. Research in artificial intelligence (AI) is developing rapidly, however, rigorous appraisal of its reliability and generalizability are necessary before its implementation. Significant vision loss from DME in pregnant women, young children and elderly patients with systemic comorbidities are challenging conundrums. An international panel of experts (IPE) comprising 36 experts from 16 countries formulated and voted on the consensus statements in 5 key areas: 1) Diagnostic controversies around classification and imaging; 2) Treatment controversies; 3) Management paradigm between protocol-based and individualized approaches; 4) Emerging controversies in novel therapeutics and AI application, and 5) Special considerations for specific patient populations. There is an imminent need for mutual agreement on the best-possible approach to DME management in order to promote the optimal patient outcomes and to identify specific issues that require prioritization of resources and research.

Keywords: causes; consensus; controversy; diabetic macular edema; diagnosis and management.

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Conflict of interest statement

Declaration of Competing Interest: Varun Chaudhary: Consultant: Roche, Bayer, Novartis, Apellis, Boehringer Ingelheim, EyePoint Pharmaceuticals Inc, Janssen; Research Grants: Bayer, Novartis, Roche Carol Y. Cheung: Co-founder of InnoEye Focus Ltd. Marion Munk: Allergan/Abbvie (C), Alcon, Alimera (C), Apellis (C), Astellas, Aviceda Therapeutics, Bayer (C), Böhringer-Ingelheim, Dandelion (C) Eyegnos consulting, Eyepoint (C), Gensight Therapeutics (C), Isarna Therapeutics (C),Iveric Bio (C), Kubota (C), Lumithera (C) Novartis (C), Oculis (C), Ocuterra (C), OD-OS, RetinAI (C), Roche (C), Zeiss (C), ONL therapeutics, Ocular Therapeutics, Evolve Medical Education, UBS analytics. Min Sagong: Consultant for and receiving grant support from Samsung Bioepis, Novartis, Bayer, Roche, Allergan/Abbvie, Celltrion, Alteogen, Alcon, Sam Chun Dang, PharmAbcine, 4D molecular therapeutics, and Curacle, and receiving lecture fee from Alcon, Novartis, Bayer, Roche, and Allergan/Abbvie. Sobha Sivaprasad: Consultant for AbbVie, Alimera Science, Amgen, Apellis, Ashvattha Therapeutics, Astellas, Bayer, Biogen, Boehringer Ingelheim, Clearside Biomedical, Eyebiotech, Eyepoint Phamaceuticals, Iveric Bio, Janssen Pharmaceuticals, Nova Nordisk, Optos, Outlook Therapeutics, Ocular Therapeutix, Kriya Therapeutics, OcuTerra, Ripple Therapeutics, Roche, Stealth Biotherapeutics and Sanofi. Stela Vujosevic: Abbvie (C), Alimera (C), Apellis (C), Adverum (C), Annexon (CI), Bayer (C), Böhringer-Ingelheim (C), RetinAI (C), Roche (C), Zeiss (C)

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Consensuses and controversies on causes, diagnosis and management of diabetic macular edema (DME)

Affiliations

Consensuses and controversies on causes, diagnosis and management of diabetic macular edema (DME)

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types