Faricimab Use in Center‑Involving Diabetic Macular Edema

Indication and Dosing Protocol

Faricimab is FDA‑approved as a first‑line anti‑VEGF therapy for center‑involving diabetic macular edema (DME); the recommended dose is 6 mg (0.05 mL) intravitreally, administered monthly for a minimum of four injections before extending intervals up to 16 weeks based on anatomic and visual response. 1

During the active treatment phase, patients should be seen every 1–3 months, with each visit including best‑corrected visual acuity assessment, OCT imaging, and evaluation for intraretinal or subretinal fluid. 2
After the loading phase, OCT should be performed monthly while treatment intervals are being extended to determine the optimal re‑treatment timing. 2

Faricimab enables significantly longer treatment intervals (up to 12–16 weeks) compared with aflibercept or ranibizumab, which typically require injections every 4–8 weeks during the first year, thereby reducing patient burden. 1
In eyes with moderate visual impairment (≈20/50 or worse), faricimab provides efficacy comparable to aflibercept while offering superior durability, making it a viable alternative to bevacizumab. 1

If DME persists despite faricimab therapy, clinicians should consider adjunctive macular laser photocoagulation or a switch to intravitreal corticosteroids. 1
In pregnant patients, macular laser photocoagulation or intravitreal corticosteroids are recommended instead of faricimab. 1
For eyes with good baseline vision (≈20/25 or better) despite center‑involving DME, close observation with deferred treatment yields 2‑year outcomes comparable to immediate anti‑VEGF initiation. 1

In low‑resource settings where the cost of faricimab is prohibitive, off‑label bevacizumab or focal laser therapy are suggested alternatives. 2

A 49-year-old female patient with type 2 diabetes and symptoms of blurred vision and difficulty reading fine print was diagnosed with diabetic macular edema in the left eye, as confirmed by OCT and dilated fundus examination, which revealed retinal hemorrhages, microaneurysms, and macular thickening 3, 4, 5, 6
The American Diabetes Association recommends intravitreal anti-VEGF agents, including faricimab, as first-line treatments for center-involved diabetic macular edema, with the patient's diagnosis meeting the criteria for treatment with anti-VEGF therapy 4, 6

The American Academy of Ophthalmology guidelines confirm that intravitreal anti-VEGF agents provide more effective treatment for center-involved diabetic macular edema than monotherapy with laser, with faricimab being one of five anti-VEGF agents currently used to treat eyes with center-involved diabetic macular edema 4, 6
Early intervention with anti-VEGF therapy is important to prevent vision loss and improve outcomes in patients with diabetic macular edema, according to the American Diabetes Association 3, 5

The administered dose of 0.05ml (6mg) of Vabysmo is consistent with the FDA-approved dosing for diabetic macular edema, with the standard treatment protocol typically beginning with monthly injections for at least 4 doses, followed by possible interval adjustments based on clinical response 4, 6, 7
Regular follow-up is essential to monitor treatment response and adjust the injection frequency as needed, with patients being monitored for rare but serious adverse events, and maintaining good glycemic control remaining important as an adjunct to intravitreal therapy for optimal management of diabetic retinopathy 4, 6, 7