Abstract
Introduction
Diabetic macular edema (DME) is a major cause of vision loss among working‑age adults in the United States. Currently, intravitreal anti-vascular endothelial growth factor (anti‑VEGF) injections are the first‑line pharmacological treatment for the management of center‑involving DME. However, real‑world outcomes with anti-VEGF injections are suboptimal due to limited durability, inconsistent follow‑up, and incomplete response.Areas covered
Novel therapeutic approaches include multi-target biologics combining VEGF inhibition with complementary pathways, non-VEGF barrier-restorative biologics, inflammation-modulating agents, small-molecule VEGF-pathway tyrosine kinase inhibitors, alternative corticosteroid delivery approaches, and ocular gene-therapy vectors.Expert opinion
Emerging therapies are likely to complement rather than immediately replace the current anti-VEGF paradigm. Durable therapies including sustained-release implants and gene therapy demonstrate promise in reducing treatment burden and integrate well into the current treatment paradigm. Combination strategies targeting VEGF alongside complementary inflammatory or vascular pathways may improve outcomes in patients with incomplete response, although prospective studies are still needed to identify the patients most likely to benefit from these approaches. Agents seeking to replace the current anti-VEGF regimens face the greatest challenges. Ultimately, the clinical adoption of these therapies will depend on demonstrating durable efficacy, an acceptable safety profile, procedural feasibility, and payer acceptance.