Assessing Quality of Life and Patient-Reported Outcomes in Diabetic Macular Edema Treated With Anti-vascular...

Diabetic macular edema (DME) is a leading cause of vision impairment, with profound effects on patients' quality of life (QoL). Anti-vascular endothelial growth factor (anti-VEGF) agents are the current standard of care, but their impact on patient-reported outcomes (PROMs) remains incompletely understood. We conducted a systematic review and meta-analysis of five randomized controlled trials (RCTs) and one cohort study involving 1,793 participants, evaluating the effects of anti-VEGF therapy compared with sham injections or laser therapy on QoL as measured by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Pooled analysis demonstrated a statistically significant improvement in composite QoL scores with anti-VEGF therapy (mean difference 3.11; 95% CI 1.89-4.33; p<0.00001), although the absolute magnitude of improvement was modest. Subgroup analysis revealed greater benefit compared with sham injections than with laser therapy, and long-term follow-up (24 months) showed more pronounced gains compared with shorter durations. Sensitivity analysis excluding the non-randomized study confirmed the robustness of these findings. While anti-VEGF therapy improves QoL in patients with DME, real-world barriers such as treatment burden, access, and cost may limit patient-perceived benefits. Future research should integrate patient-centered approaches to better capture the treatment impact beyond visual outcomes.