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Prevalence of and Risk Factors for Diabetic Macular Edema in the United States
Open accessAbstract
IMPORTANCE: Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically. OBJECTIVES: To estimate the prevalence of DME in the US population and to identify associated risk factors. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of 1038 participants aged 40 years or older with diabetes and valid fundus photographs in the 2005 to 2008 National Health and Nutrition Examination Survey. MAIN OUTCOMES AND MEASURES: The overall prevalence of DME and its prevalence according to age, race/ethnicity, and sex. RESULTS: Of the 1038 persons with diabetes analyzed for this study, 55 had DME, for an overall weighted prevalence of 3.8% (95% CI, 2.7%-4.9%) or approximately 746, 000 persons in the US 2010 population aged 40 years or older. We identified no differences in the prevalence of DME by age or sex. Multivariable logistic regression analysis showed that the odds of having DME were higher for non-Hispanic blacks than for non-Hispanic whites (odds ratio [OR], 2.64; 95% CI, 1.19-5.84; P = .02). Elevated levels of glycosylated hemoglobin A1c (OR, 1.47; 95% CI, 1.26-1.71 for each 1%; P < .001) and longer duration of diabetes (OR, 8.51; 95% CI, 3.70-19.54 for ≥ 10 vs <10 years; P < .001) were also associated with DME prevalence. CONCLUSIONS AND RELEVANCE: These results suggest a greater burden of DME among non-Hispanic blacks, individuals with high levels of hemoglobin A1c, and those with longer duration of diabetes. Given recent treatment advances in reducing vision loss and preserving vision in persons with DME, it is imperative that all persons with diabetes receive early screening; this recommendation is even more important for those at higher risk for DME.
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“For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [10]
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In the citing paper
“For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [10]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [10]
Experimental — accuracy not yet measured
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Citations
Cites
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Veritti, D., Sarao, V., Soppelsa, V., & Lanzetta, P. (2021) · Clinical ophthalmology · doi:10.2147/opth.s236423 · Cited by 26
“for more than 20 years and 71% of those with proliferative diabetic retinopathy.(2,3) Grid and focal laser photocoagulation used to be the only evidence-based treatment modality to preserve vision in patients with DME.”
BackgroundSharma, V. K., Dwivedi, L. K., Singh, S., & Mishra, G. R. (2024) · Journal of Optics · doi:10.1007/s12596-023-01597-w · Cited by 24
“It is crucial to address diabetes promptly to minimize the risk of these complications [2, 3].”
Vitrectomy for center-involved diabetic macular edema
Browning, D. J., Lee, C., Stewart, M., & Landers, M. B. (2016) · Clinical ophthalmology · doi:10.2147/opth.s104906 · Cited by 24
“In the US, ~750,000 patients are affected.(2) The standard of care for treatment of DME in developed countries is serial intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs.”
Koyanagi, Y., Yoshida, S., Kobayashi, Y., Kubo, Y., Yamaguchi, M., Nakama, T., Nakao, S., Ikeda, Y., Ohshima, Y., Ishibashi, T., et al. (2016) · Ophthalmologica · doi:10.1159/000446992 · Cited by 23
Diabetic macular oedema: clinical risk factors and emerging genetic influences
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“High levels of HbA1c are also associated independently with DMO.(19,28,29) While poor chronic glycaemic control as measured by HbA1c is a well-known risk for DR, shortterm variability in glucose levels may also correlate with development of DR.”
BackgroundLong-term Treatment Patterns for Diabetic Macular Edema
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The Impact of Race on Short-term Treatment Response to Bevacizumab in Diabetic Macular Edema
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“…of diabetic macular edema (DME) ranges from 2.1% to 7.5% in different patient populations (Heintz, 2012; Hirai, Knudtson, Klein, & Klein, 2008; Raymond et al., 2009; Varma et al., 2014); diabetic retinopathy is a major cause of severely impaired vision and blindness globally (Bourne et al., 2014).”
BackgroundInfluentialTREATMENT PATTERNS AND 2-YEAR VISION OUTCOMES WITH BEVACIZUMAB IN DIABETIC MACULAR EDEMA
Fong, D. S., Luong, T. Q., Contreras, R., Jimenez, J., Custis, P. H., Patel, V. D., & Campbell, J. H. (2017) · Retina · doi:10.1097/iae.0000000000001790 · Cited by 22
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Health Disparities in Lapses in Diabetic Retinopathy Care
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“These pathophysiologic changes can be associated with several complications, such as DME and diabetic macular ischemia (Beltramo and Porta, 2013; American Academy of Ophthalmology., 2014; Varma et al., 2014; Couturier et al., 2015; Das et al., 2015; Bradley et al., 2016).”
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“44 Therefore, diabetes duration should be taken into account when evaluating the impact of HbA1c on DRD.”
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Race and Socioeconomic Status in Anti-VEGF Treatment of Diabetic Macular Edema
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Retinal Thickness and Morphology Changes on OCT in Youth with Type 2 Diabetes
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“Data regarding the prevalence of diabetic macular edema from US-based population studies are scarce; values range from 2.7% to 3.8% and are higher in non-Hispanic Black individuals than those in non-Hispanic Whites.20,21 Results from our study cohort of primarily minority youth are overall consistent with the higher r…”
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“Compared to conventional pregnancy tests, SPR-based detection offers higher sensitivity, real-time monitoring, and a cost-effective, reusable, and environmentally friendly approach to early pregnancy diagnosis [3].”
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Self-citationYearly Treatment Patterns for Patients with Recently Diagnosed Diabetic Macular Edema
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“5% or more, or used insulin or the prescription of diabetic agents (Varma et al., 2014).”
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“InTRODuCTIOn Diabetic macular oedema (DME) is a common complication for patients with diabetes and the main cause of blindness in the non-elderly.(1) Based on previous reports, 20% of patients with type 1 diabetes and 25% of patients with type II diabetes will suffer from DME;(2) the 25-year cumulative incidences of p…”
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“This is also given added importance with the significant costs of delivering care to patients with diabetic macular edema [4] and the prevalence of DME across the world from the Americas through to Asia.”
BackgroundEnhanced blood glucose detection using SPR-based biosensor with CdS/Ag/CdS/BP nanomaterials
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“Diabetic retinopathy is the leading blinding eye disease for workingaged people and diabetic macular edema (DME) secondary to diabetic retinopathy is the direct cause of visual impairment (6).”
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Three-dimensional analysis of morphologic changes and visual outcomes in diabetic macular edema
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“HbA1c, duration of DM, and dyslipidemia are reported risk factors for DME [16, 23].”
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“DME is one of the most common causes of blindness in diabetic patients [1].”
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Sociodemographic variables associated with risk for diabetic retinopathy
Nguyen, C. T. N., Yosef, M., Khalatbari, S. H., & Shah, A. R. (2022) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-022-00144-z · Cited by 13
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“The RCTs that meet the following criteria were considered eligible: (1) participants over 18 years of age with type 1 or 2 diabetes; (2) participants with DME or PDR; (3) published number of patients, age, gender, and intervention details; (4) treatments of interest were intravitreal injection of aflibercept 2.0mg com…”
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“Additionally, most studies report prevalence rather than incidence; for example, Yau et al. (2012) [8] and Varma et al. (2014) [37] reported DME prevalence rates of 6.8% and 3.8%, respectively.”
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“8% in US diabetes and there was no difference in the prevalence of ME by age or sex [14].”
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“In the United States, nearly 1 in 25 individuals with diabetes over the age of 40 has DMO in at least one eye [2].”
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Muayad, J., Loya, A., Hussain, Z. S., Lee, D. H., Chauhan, M. Z., Lee, A. G., Movahedan, A., & Dahr, S. S. (2024) · Ophthalmology Retina · doi:10.1016/j.oret.2024.12.006 · Cited by 12
Influence of glycosylated hemoglobin on the choroidal thickness
Şahinoğlu-Keşkek, N., Altan-Yaycıoğlu, R., Canan, H., & Çoban-Karataş, M. (2017) · International Ophthalmology · doi:10.1007/s10792-017-0668-2 · Cited by 12
“Large epidemiologic studies have shown that elevated HbA1c confers an increased risk of developing diabetic macular edema [11, 12].”
Liew, G., Wong, V. W., Saw, M., Tsang, T. E., Nolan, T., Ong, S., & Ho, I. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-021884 · Cited by 11
“8% based on NHANES digital grading protocol of fundus photography.(6) This contrasts with a UK study of electronic medical records from 76 127 diabetic patients managed by the UK hospital eye service which found CSME present in 15.”
BackgroundResultGu, D., Agron, S., May, L. N., Mirza, R. G., & Bryar, P. J. (2020) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2019.0206 · Cited by 12
Pradhana, D., Swathi Priya, M. N., Surya, J., Bhende, M. P., Laxmi, G., Sharma, T., & Raman, R. (2021) · Ophthalmic Epidemiology · doi:10.1080/09286586.2021.1907846 · Cited by 12
“Age was observed to be a significant risk factor for patients with CI-DME.”
MethodResultInfluentialZhu, Y., Cai, Q., Li, P., Zhou, Y., Xu, M., & Song, Y. J. (2022) · Annals of Palliative Medicine · doi:10.21037/apm-22-102 · Cited by 12
Genetic systems for a new approach to risk of progression of diabetic retinopathy
Pinazo-Duran, M. D., Zanón‐Moreno, V., Lleó-Pérez, A., García‐Medina, J. J., Galbis-Estrada, C., Roig-Revert, M. J., Marco-Ramírez, C., Gálvez, M. I. L., Dolz‐Marco, R., Duarte, L., et al. (2016) · Archivos de la Sociedad Española de Oftalmología (English Edition) · doi:10.1016/j.oftale.2016.01.016 · Cited by 12
Tandon, A., Chen, C., Penman, A., Hancock, H., James, M., Husain, D., Andreoli, C., Li, X.-H., Kuo, J., Idowu, O., et al. (2015) · Investigative Ophthalmology and Visual Science · doi:10.1167/iovs.15-16674 · Cited by 12
“but it has been shown to be more prevalent in African Americans than in other US populations.(50) In conclusion, in this large study among African-Americans with diabetes, there is no association between PAA and PDR after adjustment for clinical, demographic, and socioeconomic factors.”
ResultDaniel, E., Grunwald, J. E., Kim, B. J., Maguire, M. G., Jaffe, G. J., Toth, C. A., Ferris, F. L., Martin, D. F., Shaffer, J., & Ying, G. (2016) · Ophthalmology Retina · doi:10.1016/j.oret.2016.09.001 · Cited by 12
“In diabetic maculopathy, HE within 1 DD of the macular center detects CSME with 94% sensitivity, and HE anywhere in the macular region predicted CSME with 89% sensitivity.(3) Although our study was not designed to evaluate the prediction of HE for CSME, the presence of HE anywhere in the macular area of eyes with trea…”
BackgroundTime to Progression to Proliferative Diabetic Retinopathy in Patients With Type 2 Diabetes
Kim, I. M., Radgoudarzi, N., Chen, E. M., Liu, J., Moussa, K., Shantha, J. G., Tsui, E. Y. K., Gore, C., Baxter, S. L., Porco, T. C., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.21150 · Cited by 11
Greenlee, T. E., Malhotra, N. A., Iyer, A. I., Conti, T. F., Chen, A. X., & Singh, R. P. (2022) · Ophthalmic surgery, lasers & imaging retina · doi:10.3928/23258160-20220615-01 · Cited by 11
Torjani, A., Mahmoudzadeh, R., Salabati, M., CAI, L. Z., Hsu, J., Garg, S. J., Ho, A. C., Yonekawa, Y., Kuriyan, A. E., & Starr, M. R. (2022) · Ophthalmology Science · doi:10.1016/j.xops.2022.100226 · Cited by 11
“Risk factors for DME include a greater duration of DM, higher hemoglobin A1c, proteinuria, pregnancy, dyslipidemia, and hypertension.(2,3) Although visual acuity (VA) has largely been used as the primary treatment outcome for DME, another potential end point includes central subfield thickness (CST) measured by OCT.”
BackgroundThe Broader Economic Value of Treatment for Diabetic Macular Edema
Mulligan, K., Kim, J., Tysinger, B., Blim, J. F., Emerson, G. G., Ferrone, P. J., Kim, J. E., Seabury, S. A., & Hahn, P. (2023) · Diabetes Care · doi:10.2337/dc22-2527 · Cited by 12
Global trends in diabetic eye disease research from 2012 to 2021
Yuan, Y., Ji, S., Song, Y., Che, Z., Xiao, L., Tang, S., & Xiao, J. (2023) · Neural Regeneration Research · doi:10.4103/1673-5374.391303 · Cited by 11
“DME can occur at any stage of DR and is characterized by an accumulation of excess fluid in the retinal macular area (Varma et al., 2014).”
BackgroundInfluentialLeng, X., Shi, R., Xu, Z., Zhang, H., Xu, W., Zhu, K., & Lu, X. (2024) · Scientific Reports · doi:10.1038/s41598-024-82007-4 · Cited by 11
Tabano, D. C., Watane, A., Gale, R. P., Cox, O., Hill, S., Longworth, L., Oluboyede, Y., Ahmed, A. M., & Patel, N. A. (2025) · Ophthalmology and Therapy · doi:10.1007/s40123-025-01180-5 · Cited by 12
“Among patients with diabetes, the prevalence of DME is approximately 3.7% in Europe [8], approximately 15.7% in Canada [9], and approximately 3.8% in the USA [10].”
InfluentialSadda, S. R., Holz, F. G., Staurenghi, G., Invernizzi, A., Arnold, J., & Tadayoni, R. (2022) · Ophthalmologica · doi:10.1159/000526703 · Cited by 11
The clinical utility of aflibercept for diabetic macular edema
Stewart, M. W. (2015) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s72792 · Cited by 12
Current intravitreal pharmacologic therapies for diabetic macular edema
Colucciello, M. (2015) · Postgraduate Medicine · doi:10.1080/00325481.2015.1052523 · Cited by 11
“DME is the most frequent cause of visual impairment in patients with diabetic retinopathy, especially impacting individuals with high levels of hemoglobin A1C, those with longer diabetes duration, and, in the United States, in nonHispanic blacks [8-10].”
BackgroundMastropasqua, L. (2019) · International Journal of Ophthalmology · doi:10.18240/ijo.2019.10.11 · Cited by 11
Scott, A. W., & Bressler, S. B. (2017) · Springer eBooks · doi:10.1007/978-3-642-35951-4_1096-2 · Cited by 11
Ethnic Variation in Diabetic Retinopathy Lesion Distribution on Ultra-widefield Imaging
He, Y., Verma, A., Nittala, M. G., Velaga, S. B., Esmaeilkhanian, H., Li, X., Su, L., Li, X., Jayadev, C., Tsui, I., et al. (2022) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2022.10.023 · Cited by 10
Blodi, B., Gardner, T. W., Gao, X., Sun, J. K., Lorenzi, G. M., de Koo, L. C. O., Das, A., White, N. H., Gubitosi‐Klug, R., Aiello, L. P., et al. (2024) · Diabetes Care · doi:10.2337/dc23-2408 · Cited by 10
Choi, E. Y., Choi, J. Y., & Yoo, T. K. (2025) · International Journal of Retina and Vitreous · doi:10.1186/s40942-025-00638-9 · Cited by 10
“Previous studies have identified demographic and biological risk factors for DR and DME through statistical analyses using national study data [25, 26].”
Impact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality
Zhu, Z., Shang, X., Wang, W., Ha, J. J., Chen, Y., He, J., Hu, W., Yang, X., & He, M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.750017 · Cited by 10
Bromeo, A. J., Grulla-Quilendrino, P., Antolin, R. C., Salcedo, E. J. J., Arcinue, C. A., Jesus, R. A. D., & Veloso, A. (2022) · International Journal of Retina and Vitreous · doi:10.1186/s40942-022-00406-z · Cited by 10
“Background Diabetic retinopathy is a major microvascular complication of diabetes mellitus and is one of the leading causes of preventable blindness in the world [1, 2].”
BackgroundRamesh, B., & Lakshmanna, K. (2023) · Computer Modeling in Engineering & Sciences · doi:10.32604/cmes.2023.028944 · Cited by 11
Different approaches in the management of macular hemorrhage: Case reports and a literature review
Quiroz-Mendoza, J. L., Valera-Cornejo, D., García-Roa, M., Ramírez-Neria, P., Villalpando-Gómez, Y., Romero-Morales, V. A., & García-Franco, R. (2020) · Medwave · doi:10.5867/medwave.2020.02.7831 · Cited by 10
Representation Matters—Diversity in Retina Clinical Trials
Baxter, S. L. (2022) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2022.3930 · Cited by 10
da Motta, A. A. L., Bonanomi, M. T. B. C., Ferraz, D., Preti, R. C., Sophie, R., Abalem, M. F., Queiroz, M. S., Pimentel, S. L. G., Takahashi, W. Y., & Damico, F. M. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.02.002 · Cited by 9
Residual Neural Network Based Classification of Macular Edema in OCT
Huang, Y., & Hu, J. (2019) · IEEE International Conference on Tools with Artificial Intelligence (ICTAI) · doi:10.1109/ictai.2019.00107 · Cited by 10
“As a result, 10 images of AMD and 6 images of DME can be detected and classified to the accuracy of 87.5% [6].”
InfluentialOuardighi, H. E., Poppe, K. G., Kleynen, P., Grabzcan, L., Veltri, F., Bruyneel, A.-V., Nguyen, P. A. H., & Bruyneel, M. (2022) · Sleep And Breathing · doi:10.1007/s11325-022-02578-2 · Cited by 9
“Indeed, the results of a cross-sectional study in 1038 diabetic patients over 40 years of age showed there was no difference in the prevalence of macular edema according to age and gender but a probability of developing it with elevated HbA1c levels [39].”
ResultKwon, J. W., & Oh, J. (2022) · Journal of Diabetes Research · doi:10.1155/2022/1897344 · Cited by 9
“Diabetic macular edema (DME) is one of the most significant causes of visual disturbance in patients with diabetic retinopathy (DR) [1, 2].”
BackgroundLang, G. E., Tadayoni, R., Tang, W., Barth, C., Weiss-Haljiti, C., Chong, V. N., & on behalf of the BI 1026706 Study Group (2020) · Translational Vision Science & Technology · doi:10.1167/tvst.9.4.25 · Cited by 9
Sistemas genéticos para un nuevo abordaje del riesgo de progresión de la retinopatía diabética
Pinazo-Duran, M. D., Zanón‐Moreno, V., Lleó-Pérez, A., García‐Medina, J. J., Galbis-Estrada, C., Roig-Revert, M. J., Marco-Ramírez, C., Gálvez, M. I. L., Dolz‐Marco, R., Duarte, L., et al. (2016) · Archivos de la Sociedad Española de Oftalmología · doi:10.1016/j.oftal.2016.01.016 · Cited by 9
Wu, C., Wu, A. M., Greenberg, P. B., Yu, F., Lum, F., & Coleman, A. L. (2018) · Ophthalmic surgery, lasers & imaging retina · doi:10.3928/23258160-20180329-05 · Cited by 9
Mason, L., Crosson, J. N., Mason, J. O., & McGwin, G. (2017) · Journal of Ophthalmology · doi:10.1155/2017/7398470 · Cited by 9
“Diabetic macular edema (DME) is a common progressive eye disease that affects an estimated 750,000 American diabetic patients [2].”
BackgroundGurung, R. L., FitzGerald, L. M., Liu, E., McComish, B. J., Kaidonis, G., Ridge, B., Hewitt, A. W., Vote, B. J. T., Verma, N., Craig, J. E., et al. (2022) · BMC Ophthalmology · doi:10.1186/s12886-022-02325-x · Cited by 8
“Of the various risk factors, poor glycaemic control is well proven to increase the risk of DME [4, 5] and a large body of evidence supports the long-term beneficial effects of tight glycemic control in diabetic patients [6].”
BackgroundThe 0.19-mg Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema
Roth, D. B., Eichenbaum, D., Malik, D., Radcliffe, N. M., Cutino, A., Small, K. W., Abdelsalam, A., Shakoor, A., Moshiri, A., Barkmeier, A. J., et al. (2023) · Ophthalmology Retina · doi:10.1016/j.oret.2023.08.004 · Cited by 8
Metadata
- Authors
- Varma, R., Bressler, N. M., Doan, Q. V., Gleeson, M., Danese, M., Bower, J. K., Selvin, E., Dolan, C., Fine, J., Colman, S., & Turpcu, A.
- Affiliations
- University of Southern California (US)
- Johns Hopkins University (US)
- Outcomes Insights, Inc, Westlake Village, California
- The Ohio State University (US)
- Genentech (US)
- Corresponding author
- Varma, Rohit
- ORCID
- Venue
- JAMA Ophthalmology
- Publisher
- American Medical Association (AMA)
- Published
- 2014-11-01
- Volume
- 132
- Issue
- 11
- Pages
- 1334
- ISSN
- 2168-6165 (ISSN-L)
- PMC
- PMC4576994
- OpenAlex
- W2075206985
- Cited by
- 423
- References
- 38
- Citations by year
- 2026: 26 · 2025: 38 · 2024: 38 · 2023: 38 · 2022: 62 · 2021: 31 · 2020: 42 · 2019: 28 · 2018: 26 · 2017: 29 · 2016: 32 · 2015: 30 · 2014: 2
- FWCI
- 29.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL007024)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetic macular edema, prevalence, risk factors, diabetes mellitus, racial disparities, non-Hispanic blacks, HbA1c, diabetes duration, vision loss, diabetic retinopathy, vision screening
- MeSH terms
- Adult, Aged, Blood Glucose, Cross-Sectional Studies, Diabetic Retinopathy, Ethnicity, Female, Health Surveys, Glycated Hemoglobin, Humans, Macular Edema, Male, Middle Aged, Nutrition Surveys, Risk Factors, United States, Prevalence, Age Distribution, Sex Distribution
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