Eye Blog

In an earlier blog I promised we would see new changes in 2015 in how we manage diabetic eye problems, specifically macular oedema. NICE (National Institute for Health and Clinical Excellence) have now approved two more injection therapies for diabetic macular oedema (DMO) so we now have a choice of four drugs: ranibizumab (Lucentis) and Iluvien and the 'new kids on the block' aflibercept (Eylea) and dexamethasone (Ozurdex) implant.

Believe it or not, approving the drug was the easy bit. Knowing which drug to use is where the clinical expertise lies. Of course there will be published guidance from the usual professional bodies and heavy weights but having written our local departmental guidance one thing is clear to me: there will be no simple algorithm to follow.

The decision behind choosing the appropriate treatment, while underpinned by the specific pharmacological qualities of each drug, will depend on each individual patients' needs and should be arrived at through a process of informed discussion. Both Ozurdex and Iluvien are long-acting steroid implants and require fewer treatments, however both can cause the eye pressure to increase leading to a condition called glaucoma.

In the NHS setting, their use is allowed only if other treatments have failed and in eyes that have had cataracts removed. Lucentis and Eylea do not have any long-term effect on eye pressure but do require frequent monthly treatment and monitoring in the initial phases with an average of 8 injections administered in the first year alone.

All these factors must be taken into account while planning the best treatment regime for DMO.