Synergising Macular Function and Structure in Diabetic Macular Oedema to Improve Patient Care: An International Delphi Consensus

INTRODUCTION: The correlation between diabetic macular oedema (DMO) structural and functional assessments and their reflection of patient impact lacks consensus. This study aims to understand the ophthalmology community's thoughts on optimising patient care by improving functional and structural assessments. METHODS: The process employed a modified Delphi methodology. Following a literature review, a steering committee of six experts developed 40 statements under three consensus topics. The statements were globally distributed via an online, four-point Likert scale survey using a snowball sampling technique. RESULTS: Survey responses (n = 93) were collated anonymously and independently analysed. Consensus was achieved in 35 statements (88%). There was strong agreement that routinely used assessments for DMO may not accurately reflect the level of vision impairment experienced by the patient and that there is a need for a composite functional assessment (of two or more tests) to demonstrate better correlation with structural changes. The correlation of anatomical features like central subfield thickness, epiretinal membrane, intraretinal fluid, and subretinal fluid volumes with visual acuity outcomes remain uncertain. CONCLUSION: This consensus supports the need to develop a composite assessment to improve patient care. Utilising contrast sensitivity, distance and near low luminance, and novel patient-reported outcome measures may improve patient-centric assessments to better understand the patient's quality of life and functional experience.