Real-world outcomes of anti-vascular endothelial growth factor therapy in diabetic macular edema in the united states

The authors are commenting on the article entitled “Real-world of anti-vascular endothelial growth factor therapy in diabetic macular edema in the United States” published by Ciulla et al. in Ophthalmology Retina; http:/dx.doi.org /10.1016/j.oret.2018.06.004. Published online July 28, 2018.The conclusion resulting from this article is that regardless of the intravitreal pharmacotherapy chosen, namely, specific (bevacizumab, ranibizumab or aflibercept) or nonspecific (corticosteroid implant) anti-vascular endothelial growth factor agents, the efficacy of the treatment depends primarily on the promptness of the therapy after diabetic macular edema diagnosis. The validation, extrapolation, and generalizability of the authors’ conclusion can be made only by statistical analyses including all the missing baseline potential predictive factors mentioned by us in addition to the baseline characteristics already evaluated in the study, which serve as potential prognosticators influencing functional and anatomic improvements.