As this issue of Retina Today is sent to press, the US government is facing a potentially dire economic situation, risking defaulting on its debts and losing its triple A credit score due to myriad factors that are currently the subject of last-minute debate in Congress. This is bad news.

More bad news: Health care reform. Really, is anyone outside of the medical community paying attention to this issue any longer? Heath care reform is like the toothache that went away when we got shot in the foot by the economy. The health care issue still has not been resolved, however, and physicians are still going to see millions of new patients with public and private insurance coming through their office doors. For the retina specialist this news is pertinent indeed, as many of these patients will have severe diabetes.

And even more related bad news? As we all know, obesity and obesity-associated complications—including diabetes— are growing at epidemic proportions. Reports estimate that the number of people in the United States over age 65 will double by 2030 to approximately 70 million. This news becomes even worse if we have a health care system that cannot handle these numbers.

Now, how about some good news for a change? In the July 2011 issue of Nature Genetics, researchers reported on a gene that may be linked to metabolic factors such as body mass index, cholesterol, insulin, and glucose in type 2 diabetes and that may lead to successful treatments for the disease. If this research bears fruit, it could help to control the coepidemics of obesity and diabetes and bring at least a portion of health care costs under control.

And in other good news, our retina subspecialty has made enormous breakthroughs in recent years in how we are able to care for patients with diabetic retinopathy. The cover focus in this issue spotlights some of these advances.

Notably, it seems we have found a therapy that is more effective than focal/grid laser for treatment of diabetic macular edema (DME). Members of the Diabetic Retinopathy Clinical Research Network (DRCR.net) have demonstrated that in patients with DME, ranibizumab (Lucentis, Genentech) with prompt or deferred laser produced superior anatomic and functional outcomes through 2 years' follow-up, providing several letters more of mean visual acuity improvement in comparison with laser. The results of this apparently paradigm-changing study, hopefully ushering in a new gold standard treatment for DME, are outlined in an article in this issue reviewed by Susan B. Bressler, MD, one of the DRCR.net investigators.

Further, promising results in patients with DME have been reported for another vascular endothelial growth factor (VEGF) inhibitor—a drug that is almost at the proximal end of the research pipeline, aflibercept (formerly VEGF Trap- Eye, Regeneron Pharmaceuticals/Bayer HealthCare). In a phase 2 study in patients with DME, recapped in this issue in an article reviewed by David M. Brown, MD, treatment with aflibercept resulted in statistically significant improvements in vision in comparison with laser. A phase 3 study in DME is under way, and aflibercept has been recommended for approval as a treatment for age-related macular degeneration by an advisory committee to the US Food and Drug Administration. Approval could come as early as this month.

Promising results in patients with DME have also been reported for several extended- release formulations of cortocosteroids, which are reviewed in an article by Anat Loewenstein, MD. And José Cunha-Vaz, MD, PhD, suggests how steroids may be helpful to improve outcomes in patients with DME who respond poorly to anti-VEGF therapy. Further, Anselm Kampik, MD, reminds of the still-important role of vitrectomy and the rationale for its use in certain patients with DME. Finally, Igor Kozak, MD, explains the potential benefit of a navigated laser delivery device for use in combination with all these new therapeutic options for DME.

There now. Feel better? We hope this issue brings some good news to the retina community in what has been a rough summer so far.