Diabetic macular edema (DME) is a condition that affects a person’s eyesight that can happen after a diabetic patient develops retinopathy. A major issue with this condition is that it often affects the patient’s ability to drive because of their loss of visual acuity (VA). One medication, ranibizumab, is said to significantly lower the risk for substantial visual acuity either by itself or in combination with laser treatment compared to observation alone or macular laser alone. This study was done to specifically analyze and evaluate the impact that ranibizumab can have on the ability of DME patients to drive. There were three different methods involved: RESTORE, RIDE, and RISE. In RESTORE, patients were deemed eligible for laser surgery and had a VA letter score between 78 and 39. They were then either given ranibizumab monotherapy, ranibizumab combination therapy (with laser therapy), or laser monotherapy. In RIDE and RISE, patients either got sham injection, 0.3 mg ranibizumab, or 0.5 mg ranibizumab. Macular laser could be used in any arm as long as the participant met the requirements. In all the trial types, each patient only had one eye treated with the experimental treatment while the other one was treated with the standard of care.
Compared with sham or macular laser therapy in all three of the methods, ranibizumab therapy allowed patients with visual impairment due to DME to report at a greater frequency that they were driving at 12 or 24 months if they were not driving at the onset of treatment. Those using ranibizumab treatment reported less difficulty with driving during the daytime in familiar places, driving at night, and driving in difficult conditions, such as bad weather, during rush hour, on the freeway, or in city traffic. This study ultimately shows that a patient treated for DME with ranibizumab is more likely to be driving 24 months after they start taking the medication. This article made me happy that medication is advancing to allow patients to better manage other disease that come along with diabetes. There are so many complications that occur with this one disease that it is nice to see more and more improvements with them. It is amazing that medication can bring a patient’s eyesight that was almost totally gone back to where they can see well enough to drive. This type of improvement must be amazing for the patient.
Bressler NM, Varma R, Mitchell P, et al. Effect of ranibizumab on the decision to drive and vision function relevant to driving in patients with diabetic macular edema. JAMA Opthalmol. 2016;134:160-66.