Glassman AR, Baker CW, Beaulieu WT, et al. - In this secondary analysis of a randomized clinical trial, researchers evaluated the DRCR Retina Network protocol-defined approach and outcomes of initial observation with aflibercept only if visual acuity (VA) worsened. Participants in the study were 236 adults, median age was 60 years, (236 eyes) with T1D or T2D, 1 study eye with CI-DME, and VA letter score at least 79 (Snellen equivalent, 20/25 or better) assigned to initial observation. Eighty of 236 eyes were treated with aflibercept during 2 years of follow-up. Candidates who had thicker retinas, more severe diabetic retinopathy, or a nonstudy eye undergoing diabetic macular edema treatment were more likely to receive aflibercept within 4 months of baseline. The findings suggest that it is necessary for clinicians who treat eyes with center-involved diabetic macular edema and good VA to consider the approach to initial observation.