Using Intravitreal Steroids Alone or in Combination to Treat DME/DR— A…


CME Information

Release Date: April 30, 2019 
Last Reviewed: April 25, 2019
Expiration Date: April 30, 2020
Time to Complete Activity: 0.25 hour

This activity is provided by Global Education Group. Paradigm Medical Communications, LLC is the educational partner.
Paradigm Medical Communications

Arshad M. Khanani, MD, MA (Chair)

Clinical Associate Professor
University of Nevada, Reno School of Medicine
Managing Partner, Director of Clinical Research, Director of Fellowship
Sierra Eye Associates 
Reno, NV

Roger A. Goldberg, MD, MBA
Bay Area Retina Associates
Department of Ophthalmology
California Pacific Medical Center
Walnut Creek, CA

Nadia K. Waheed, MD, MPH
Associate Professor of Ophthalmology
Tufts University Medical School 
Boston Image Reading Center
Boston, MA

Target Audience
This activity has been designed to address the educational needs of retina specialists and ophthalmologists. It may also benefit optometrists and other healthcare professionals (HCPs) involved in the management of patients with diabetic macular edema (DME) and diabetic retinopathy (DR).

Statement of Need
Retina specialists and ophthalmologists play a critical role in the management of DME and DR, conditions that are among the most common causes of blindness among working-aged people throughout the world. Agents that target vascular endothelial growth factor (VEGF) are typically used first-line, except in cases of pseudophakic eyes or those requiring rapid anti-inflammatory effects; however, 30% of patients do not respond to this treatment. Patients who are refractory to this treatment should be treated with intravitreal steroids or a combination of intravitreal steroids and an anti-VEGF agent. Angiogenesis and inflammation contribute to the pathophysiology of DME and DR and provide the therapeutic treatment targets. This case-based simulation activity is designed to illustrate the role of these major processes and how different agents target these pathways, and the safety and efficacy data supporting the use of intravitreal steroids and combination anti-VEGF to maximize visual outcomes in patients with DME and DR. 

Learning Objectives
Upon proper completion of this activity, participants should be better able to:

  • Identify how key elements of inflammatory-mediated mechanisms and angiogenesis-mediated mechanisms work together in the pathophysiology of DME and DR
  • Describe how the mechanisms of action of anti-VEGF agents and intravitreal steroids target inflammation and angiogenesis pathways in patients with DME and DR
  • Develop treatment strategies for patients with DME and DR using intravitreal steroids alone or in combination with anti-VEGF treatments, based on current clinical data

Physician Accreditation Statement
Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physician Credit Designation Statement
Global Education Group designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

PA Continuing Education
PAs may claim a maximum of 0.25 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

Nurse Practitioner Continuing Education
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Term of Offering
This activity was released on April 30, 2019 and is valid for one year. Requests for credit must be made no later than April 29, 2020. 

For information about the accreditation of this program, please contact Global at (303) 395-1782 or [email protected].

Disclosure of Commercial Support
This activity is supported by an educational grant from Allergan, Inc.

Instructions for Participation 
To receive a CME certificate of participation, participants must:

  • Follow instructions to register or log in with your professional information and complete the pretest
  • View the online activity in its entirety
  • Complete and submit the online posttest and evaluation. 

A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949.

There is no fee required for participation in this activity.

Hardware/Software Requirements
This certified CME activity is designed using HTML5 media controls. 

Supported Browsers:
For desktops (Windows/Mac)

Internet Explorer 9 or higher, Firefox 28 or higher, Safari 5.1 or higher, Google Chrome 31 or higher, Opera 21 or higher

For Tablets (iPad/Android/Surface)
iOS Safari 4 or higher, Android 2.3 or higher, IE Mobile 10 or higher

Technical Support: If you have any technical problems or playback issues, please email us at [email protected]

Disclosure and Resolution of Conflict of Interest
Global Education Group (Global) and Paradigm Medical Communications, LLC (Paradigm) require instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global and Paradigm for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. 

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter

Reported Financial Relationship

Arshad M. Khanani, MD, MA

Grant/Research Support: Allergan, Inc; Genentech, Inc; Novartis Pharmaceuticals Corporation

Retained Consultant: Allergan, Inc; Genentech, Inc; Novartis Pharmaceuticals Corporation

Speakers Bureau (self and spouse/partner): Allergan, Inc; Genentech, Inc; Novartis Pharmaceuticals Corporation

Roger A. Goldberg, MD, MBA

Grant/Research Support: Genentech, Inc, Santen Pharmaceutical; Zeiss
Retained Consultant: Allergan, Inc; Genentech, Inc; Regeneron Pharmaceuticals, Inc
Speakers Bureau: Allergan, Inc; Genentech, Inc

Nadia K. Waheed, MD, MPH


Grant/Research Support: Lions

Retained Consultant: Apellis Pharmaceuticals; Astellas Pharma Inc; Genentech, Inc; Heidelberg Pharma; Nidek Inc; Novartis Pharmaceuticals Corporation; Ocudyne; Regeneron Pharmaceuticals, Inc; Topcon Corporation; Zeiss

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager

Reported Financial Relationship

Lindsay Borvansky

No financial relationships to disclose

Andrea Funk

No financial relationships to disclose

Liddy Knight

No financial relationships to disclose

Ashley Cann

No financial relationships to disclose

Sarah Kaiser

No financial relationships to disclose

Sally Haas

No financial relationships to disclose

William Riley

No financial relationships to disclose

Elizabeth McSpiritt

No financial relationships to disclose

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global and Paradigm do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Signed statements of informed consent granting permission for publication have been obtained for all photographs and videos in which an individual can be identified.

As an ACCME-accredited provider, Global and Paradigm’s activities must include a balanced view of therapeutic options. Use of generic names contributes to this impartiality. The use of trade names should not be viewed as an endorsement of specific products by Global or Paradigm. 

Terms of Use and Privacy Policy
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. Any views or opinions presented are solely those of the faculty, and do not necessarily represent those of Global Education Group or Paradigm Medical Communications, LLC. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Global or Paradigm. Global and Paradigm accept no liability for the content referenced in this activity.

Privacy policy
Global and Paradigm are committed to protecting the privacy of those who participate in the activities located at (herein referred to as “website”). The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.

Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.

Collection and use of your personal information
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME activity. All evaluative information submitted is collected and retained, and used by Global and Paradigm to continuously improve the learning experience.

Global Education Group and Paradigm Medical Communications, LLC do not transfer, sell, or share personal information with outside parties. Global Education Group and Paradigm will not otherwise disclose personal information unless required to in a legal process. Global and Paradigm staff members review individual test results to the extent necessary to record and track participants’ credits.

Contact Us
If you have any questions or comments, please email us at [email protected]

© 2019 Paradigm Medical Communications, LLC, except where noted. Content may not be reproduced in whole or part without the express written permission of Paradigm Medical Communications, LLC.


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