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Review Diabetic Macular Oedema The Importance of Ocular, Systemic and Psychosocial Factors in the Management of the Diabetic Macular Oedema Patient with Anti-vascular Endothelial Growth Factor Therapy Expert Recommendations and Literature Review Richard Gale, 1 Angela Carneiro, 2 Julie de Zaeytijd, 3 Paul Dodson, 4 Sascha Fauser, 5 João Figueira, 6 Michael Larsen, 7 Nicolas Leveziel, 8 Michael Kapusta, 9 Jose M Ruiz-Moreno, 10 Enrico Peiretti, 11 Christian Pruente, 12 Reiner O Schlingemann 13 and Christoph Scholda 14 1. York Teaching Hospital NHS Foundation Trust, York, UK; 2. University of Porto and Department of Ophthalmology of Hospital São João, Portugal; 3. Ghent University Hospital, Ghent, Belgium; 4. Heartlands Hospital and Aston University, Birmingham, UK; 5. University Hospital of Cologne, Cologne, Germany; 6. Centro Hospitalar e Universitário de Coimbra and Faculty of Medicine of the University of Coimbra, Coimbra, Portugal; 7. Glostrup Hospital and National Eye Clinic, University of Copenhagen, Copenhagen, Denmark; 8. University Hospital Center of Poitiers, Poitiers, France; 9. McGill University, Montréal, Canada; 10. Castilla La Mancha University, Ciudad Real, Spain; 11. University of Cagliari, Cagliari, Italy; 12. University of Basel, Basel, Switzerland; 13. Academic Medical Center, Amsterdam-Zuidoost, The Netherlands; 14. Medical University of Vienna, Vienna, Austria A comprehensive list of patient features that influence the management of patients with diabetic macular oedema (DMO) is discussed. These features are grouped into three overarching themes: ocular, systemic and psychosocial. Consensus statements about the relative importance of these features, supported by the literature, were formed by a panel of retinal experts. The major drivers influencing the management of DMO with anti-vascular endothelial growth factor (anti-VEGF) therapy are undoubtedly ocular specific, in particular visual acuity and optical coherence tomography (OCT) central retinal thickness. Systemic factors, such as control of glycated haemoglobin (HbA 1c ), blood pressure and serum lipid estimations, have limited direct influence on DMO management although they remain important considerations to communicate to the primary diabetic physician. A greater understanding is required on how many other factors, in particular psychosocial factors, influence the care of the DMO patient. Keywords Diabetic macular oedema; management recommendations; anti-vascular endothelial growth factor; visual acuity; optical coherence tomography Disclosure: Richard Gale has worked as a consultant for Novartis and Bayer. Angela Carneiro has participated in advisory boards for Allergan, Bayer, Alcon, Novartis and Alimera. Julie de Zaeytijd has participated in advisory boards and/or consultancy for Allergan, Bayer, Novartis and Abbott, and lectured for Novartis. Paul Dobson has particpated in consultancy with Bayer. Sascha Fauser is a consultant to Quantel, Novartis, Bayer and employee of Roche. João Figueira has participated in advisory boards of Bayer, Allergan, Novartis, Alcon and Alimera. Nicolas Leveziel has participated in advisory boards of Bayer, Allergan and Novartis. Michael Larsen and the Rigshospitalet have received compensation for participation in clinical trials, presentation of lectures, consulting and advisory boards from Novartis, Eli Lilly, Pfizer, Novo Nordisk, Alcon, GlaxoSmithKline, Roche, Allergan, Bayer, Astra-Zeneca, MDS and Boehringer Ingelheim. Michael Kapusta has participated in advisory boards of Bayer, Allergan, Novartis, Alcon and Arctic. Jose M Ruiz-Moreno has participated in advisory boards of Bayer, Allergan and Novartis. Enrico Peiretti has participated in advisory boards of Bayer, Allergan and Novartis. Christian Prunte is an advisory board member for Acucela, Alcon, Bayer and Novartis. Reinier O Schlingemann is a consultant for Bayer, Novartis, Astellas, Boehringer Ingelheim and Thrombogenics, received speaker fees from Bayer and unrestricted grant support from Novartis. Christoph Scholda has nothing to disclose in relation to this article. Acknowledgements: Medical writing assistance was provided by Catherine Amey and James Gilbart, Touch Medical Media UK, funded by Bayer. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 2 November 2016 Accepted: 6 December 2016 Citation: European Ophthalmic Review, 2016;10(2):117–24 Corresponding Author: Richard Gale, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK. E: Support: The publication of this article was supported by Bayer. The views and opinions expressed are those of the author and do not necessarily reflect those of Bayer. TOU CH MED ICA L MEDIA Diabetic macular oedema (DMO) is one of the leading causes of visual impairment in working adults. 1 The implications of blinding due to DMO, including the loss of productivity and reduced quality of life (QoL), lead to a considerable socioeconomic burden on communities. 2–5 Intravitreal treatment options, particularly with anti-vascular endothelial growth factor (anti-VEGF) agents, have shown the potential to reduce visual loss far beyond that achieved with laser therapy alone. 6–10 Applying principles learnt from key clinical trials to the real world setting requires an understanding of the many patient-related factors that determine when and how treatment is started and continued. It is important for clinicians to not only understand such factors but also the evidence base for such. The aim of this article is to bring clarity to the available data on the key patient-related factors that influence the treatment of DMO, by reviewing the literature, forming consensus statements and providing recommendations. Discussions are based around the optimum scenario in an ideal world where certain barriers were removed, for example, costing, reimbursement and resource capacity. Due to the broad nature of this topic and because anti-VEGF therapy is the commonest intravitreal intervention for DMO, the scope of the discussion is largely limited to treatment with anti-VEGF therapy. Methods A panel of 15 retinal experts (see Table 1) met on 14–15 November 2014 in Zurich, Switzerland, where the need for clarity of the factors that influence DMO management was initially discussed. The panel met again on 10–11 April 2015 in Berlin, Germany, and on 6–7 November 2015 in Paris, France, to take the work forward. Based on a Delphi-style methodology, 11 a range of factors in the management of a patient with DMO were identified and the evidence for, and relative importance of 117