Van Aken E, Favreau M, Ramboer E, et al. - In this open-label, observational, multicenter study (VISION), researchers sought to assess long-term real-world treatment patterns and associated efficacy and safety outcomes in patients with diabetic macular edema (DME) treated ≥ 36 months with 0.5mg ranibizumab. This investigation was carried out in 9 Belgian clinics. Between August 2014 and March 2015, the primary treated eyes of 55 DME patients were included and followed for 3.5 ± 1.8 years. Data reported that the mean ± SD number of treatments in the first year was 5.1± 3.0 (TX-naïve), 4.5± 2.7 (PRIOR-anti-VEGF) and 5.6 ± 3.1 (PRIOR-other). This real-world study confirms the efficacy of ranibizumab in preventing BCVA decline and has shown initial improvement and subsequent BCVA retention in DME patients ≥ 36 months. Ranibizumab initially decreased and then maintained CRT, however, such data show that treatment intensity and BCVA and CRT outcomes are lower than those observed in early efficacy trials. Under-treatment possibly accounts for this efficacy-effectiveness gap. However, intravitreal ranibizumab, under conditions of significant heterogeneity in patients and treatment patterns, is an efficient and safe long-term treatment of DME.