Zhihui Dong and her team at The Third Affiliated Hospital of Wenzhou Medical University in Ruian City, China, are reimagining how diabetic macular edema (DME) — a leading cause of vision loss in people with diabetes — can be treated more efficiently without sacrificing outcomes. In a 25-week observational study, their novel '1 + 1 + PRN' regimen not only matched the effectiveness of the standard '3 + PRN' approach but did so with fewer injections, offering new hope for patients burdened by frequent eye treatments. With over 537 million adults living with diabetes worldwide, and roughly 7% developing DME, this kind of innovation could significantly ease the strain on both patients and healthcare systems.
The study compared two treatment paths for DME, a condition where fluid builds up in the macula, blurring central vision. The conventional '3 + PRN' regimen involves three monthly anti-VEGF injections — drugs that reduce abnormal blood vessel growth and leakage — followed by as-needed (pro re nata, or PRN) treatments. Dong’s team tested a streamlined alternative: one or two initial anti-VEGF injections, followed by a single dexamethasone (DEX) implant, which delivers sustained anti-inflammatory therapy, and then PRN management moving forward. The results were compelling. Across 12 eyes in 10 patients on the new regimen and 16 eyes in 13 patients on the standard, both groups showed significant improvements in visual acuity, central macular thickness (CMT), and retinal biomarkers like cyst area and hyperreflective foci. But the '1 + 1 + PRN' group stood out for its stability — CMT decreased steadily without the mild fluctuations seen in the control group, suggesting more consistent disease control.
Most strikingly, patients on the novel regimen required significantly fewer intravitreal injections over the 25 weeks, reducing treatment burden without compromising safety. Elevated intraocular pressure, a known risk of steroid use, occurred at similar rates in both groups, indicating the DEX implant did not increase complications. While the visual gains in the '1 + 1 + PRN' group were numerically better, the difference wasn’t statistically significant — yet the trend, combined with greater therapeutic stability and fewer injections, points to a meaningful advance. For patients juggling chronic conditions, fewer clinic visits can mean better adherence, less anxiety, and improved quality of life.
This small but insightful study opens the door to more personalized, efficient care for DME. As researchers continue to refine treatment protocols, the goal is clear: maintain vision, minimize interventions, and put patient well-being at the center. With further validation, this approach could become a new benchmark in retinal therapy — proving that sometimes, less can indeed be more.