The Early Treatment Diabetic Retinopathy Study historical review and relevance to today's management of diabetic macular edema

To provide an historical review of the Early Treatment Diabetic Retinopathy Study (ETDRS) in the management of diabetic macular edema (DME), and to discuss its relevance to the management of DME.The ETDRS reported that argon laser treatment is beneficial in the management of 'clinically significant' DME. The study provided guidelines for the treatment with focal and/or grid laser based on fluorescein angiographic patterns. In today's world, with the advent of optical coherence tomography, 'clinically significant' DME is now classified into center-involved DME (CI DME) and noncenter-involved DME (non-CI DME). Modified ETDRS focal/grid laser photocoagulation has been utilized in more recent clinical trials [diabetic retinopathy clinical research (DRCR) Protocols I and T] in combination with intravitreal injections.The ETDRS provided outcomes data for DME, both untreated and following laser therapy. In the management of patients with DME today, the modified ETDRS focal/grid laser photocoagulation treatments remain relevant in combination with anti-vascular endothelial growth factor (anti-VEGF) therapy as ophthalmologists and their patients choose how best to treat DME. Ongoing studies in eyes with DME, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified ETDRS focal/grid laser in the treatment of DME.