A Pivotal Moment in Retinal Medicine
For decades, laser therapy was the only option for patients with diabetic macular edema (DME) — the leading cause of vision loss among working-age adults with diabetes. That changed with the publication of DRCRnet Protocol I, a nationwide clinical trial that demonstrated the superiority of anti-VEGF injections over laser alone.
Dr. Michael J. Elman served as the national Study Chairman of this landmark trial, which was sponsored by the National Eye Institute (NEI) and conducted through the Diabetic Retinopathy Clinical Research Network (DRCRnet). The initial results were published in the New England Journal of Medicine in 2010, with extended follow-up data published in Ophthalmology in 2012.
What the Study Found
Protocol I enrolled hundreds of patients across multiple centers to compare three treatment strategies for DME:
- Intravitreal ranibizumab (an anti-VEGF medication) plus prompt or deferred laser
- Intravitreal triamcinolone (a corticosteroid) plus prompt laser
- Laser therapy alone (the previous standard of care)
The results were clear: patients treated with ranibizumab plus deferred laser achieved significantly better visual outcomes compared to laser alone. According to the study published in the New England Journal of Medicine, the ranibizumab groups gained an average of 9 letters of visual acuity at one year, compared to 3 letters in the laser-only group.
Why This Matters for Patients
Protocol I fundamentally changed how retina specialists treat diabetic eye disease worldwide. Before this study, patients with DME faced the prospect of laser burns near their central vision. Today, thanks in part to Dr. Elman's leadership of this research, anti-VEGF therapy is the first-line treatment for DME — offering better vision outcomes with fewer side effects.
As noted by the American Academy of Ophthalmology (AAO), the DRCRnet studies, including Protocol I, are among the most influential clinical trials in the history of ophthalmology. Dr. Elman also served on the DRCRnet Executive Committee and chaired it twice, reflecting his central role in shaping modern retinal care.
Continued Research Leadership
Dr. Elman has authored more than 250 peer-reviewed publications on retinal diseases and surgery. He remains committed to clinical research, and patients at the Elman Retina Group may have access to investigational therapies through our ongoing participation in clinical trials.
If you have diabetic eye disease and would like to learn about current treatment options or clinical trials, please call 410-686-3000 to schedule an appointment.
