Fig. 3 Corresponding fluorescein angiogram

of the fundus photograph in Fig. 1 demonstrating microaneurysms for which direct (focal) treatment would be applied; additional grid treatment would be applied to additional areas of macular thickening not corresponding to microaneurysms.

Source: Reprinted with permission from the Department of Ophthalmology. The University of Iowa Carver College of Medicine

injections at not only reducing the risk of substantial vision loss (approximately two or more lines) to about one out of five cases, but also increasing the chance of substantial vision gain (approximately two or more lines) to about one out of three.6 Since the results of the DRCR.net study suggested that intravitreal corticosteroids likely led to superior outcomes compared with no treatment, studies are underway to determine if combining laser with intravitreal corticosteroids leads to superior outcomes compared with laser alone. Furthermore, preliminary data also show improvement in vision following treatment of diabetic macular edema with antivascular endothelial growth factor drugs, such as ranibizumab7; thus, studies are underway to determine if these drugs alone, or in combination with focal/grid laser are superior to focal/grid laser alone or superior to focal/grid laser plus corticosteroids.

Management of the Level of Diabetic Retinopathy

Regardless of whether macular edema is present, the ophthalmologist also must determine the level of retinopathy, which could range from no diabetic retinopathy, to mild nonproliferative diabetic retinopathy, to moderate to severe nonproliferative diabetic retinopathy, and to proliferative diabetic retinopathy. If severe nonproliferative diabetic retinopathy is noted (either of the following: (1) 4 or 5 fields of severe micronaneurysms (Fig. 4, Standard 2A), (2) at least 2 fields of definite venous beading (Fig. 5, Standard 6A), or (3) at least 1 field of moderate