Abstract / Summary
Abstract Background/Objectives : Diabetic macular oedema (DMO) is a leading cause of visual impairment. While intravitreal therapies improve visual acuity, evaluating vision-related quality of life (VRQoL) is essential to comprehensively capture functional outcomes and treatment burden. Subjects/Methods: A PRISMA-compliant systematic search of Scopus, Medline(OVID), Web of Science, and PubMed was conducted from inception to July 2025. Included studies assessed pre- and post-treatment VRQoL changes using validated tools. Risk of bias was assessed using the Cochrane tool for randomised trials and the Newcastle-Ottawa scale for non-randomised studies. Results The review included 21 manuscripts encompassing 18 unique clinical trials. The majority of studies (89%) utilised the NEI VFQ-25. Anti-VEGF therapies demonstrated clinically meaningful short-term improvements with ranibizumab in multiple trials yielding mean NEI VFQ-25 composite score gains of 5–10 points at 6–12 months. However, these early gains were diminished or no-longer statistically significant over longer time periods in longitudinal extension studies. Intravitreal corticosteroids had limited evidence with heterogeneous outcome measures making it difficult to draw definitive conclusions. A critical evidence gap was identified with no VRQoL data found for newer, extended-dosing anti-VEGF agents (8mg aflibercept, faricimab) and the recently introduced biosimilars. Conclusions Intravitreal anti-VEGF agents provide significant short-term improvements in VRQoL for patients with DMO. The attenuation of long-term benefits suggests the cumulative burden of chronic injections may eventually offset functional gains. Incorporating standardised VRQoL measures with predefined clinical significance thresholds into trials and clinical therapy of emerging therapies the recently adopted biosimilars is key to ensure new treatments translate into sustained, patient-centred benefits.