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DRCR Retina Network Protocol V addressed an important clinical question: how aggressively should clinicians treat center-involving diabetic macular edema when visual acuity is still good? The randomized trial compared initial aflibercept, focal/grid laser, and observation in eyes with center-involving DME and good visual acuity. The results showed that an immediate injection strategy did not produce a clinically important visual-acuity advantage over observation or laser at the population level when rescue aflibercept was available for prespecified visual decline. The study helped reinforce a more individualized approach to treatment, where OCT anatomy and visual function are interpreted together rather than automatically triggering injections for every center-involving edema finding. For clinicians, this is especially useful in patients with preserved central vision, where injection burden, patient preference, treatment access, and the likelihood of progression all matter. Protocol V does not mean that DME should be ignored; it supports structured monitoring and timely initiation of anti-VEGF when visual loss develops. The study therefore remains a practical framework for balancing overtreatment against the risk of delayed intervention.
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DRCR Retina Network Protocol V addressed an important clinical question: how aggressively should clinicians treat center-involving diabetic macular edema when visual acuity is still good? The randomized trial compared initial aflibercept, focal/grid laser, and observation in eyes with center-involving DME and good visual acuity. The results showed that an immediate injection strategy did not produce a clinically important visual-acuity advantage over observation or laser at the population level when rescue aflibercept was available for prespecified visual decline. The study helped reinforce a more individualized approach to treatment, where OCT anatomy and visual function are interpreted together rather than automatically triggering injections for every center-involving edema finding. For clinicians, this is especially useful in patients with preserved central vision, where injection burden, patient preference, treatment access, and the likelihood of progression all matter. Protocol V does not mean that DME should be ignored; it supports structured monitoring and timely initiation of anti-VEGF when visual loss develops. The study therefore remains a practical framework for balancing overtreatment against the risk of delayed intervention.
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