
To compare visual acuity (VA) change at 24 months with clinically significant DME (CSDME) and good VA initially treated versus initially observed in routine clinical practice. This study identified 150 eligible eyes (98 initially observed, 52 initially treated) of 130 patients. The proportion of eyes with at least a 5‐letter VA loss at 24 months was not significantly different between the groups: 65% with initial observation and 42% with initial treatment (p = 0.39). However, initially observed eyes were more likely to have a 10‐letter VA loss at 24 months. Most eyes in the initial observation group received at least one treatment (an intravitreal injection in 66% and macular laser in 20%) during the 24 months. The risk of 5 letters loss was similar between both management groups. However, eyes were initially observed at risk of developing moderate visual loss and more than 80% of the required treatment over 24 months.
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