Iluvien
Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema and Posterior Uveitis
Quick Facts About Iluvien
Key Takeaways About Iluvien
- Long-acting treatment: A single Iluvien implant delivers sustained corticosteroid therapy for up to 36 months, significantly reducing the need for repeated injections compared to anti-VEGF treatments
- For chronic DME and posterior uveitis: Iluvien is specifically indicated for chronic diabetic macular edema that has responded inadequately to other treatments, and for preventing relapse of non-infectious posterior uveitis
- Risk of raised eye pressure: Increased intraocular pressure (IOP) is very common and may lead to glaucoma – regular monitoring is essential throughout the treatment period
- Cataract formation is very common: Most patients who have not previously had cataract surgery will develop lens clouding, which may require surgical removal
- Specialist administration only: Iluvien must be injected into the eye by an experienced ophthalmologist under sterile conditions in a clinical setting
What Is Iluvien and What Is It Used For?
Iluvien is a tiny intravitreal implant containing fluocinolone acetonide, a potent synthetic corticosteroid. It is inserted into the vitreous cavity of the eye by an ophthalmologist and continuously releases the drug for up to 36 months to treat chronic diabetic macular edema (DME) and prevent relapse of recurrent non-infectious posterior uveitis.
Iluvien consists of a very small tube – approximately 3.5 mm long and 0.37 mm in diameter – that is pre-loaded into a specially designed applicator. The tube is made of polyimide and contains 190 micrograms of fluocinolone acetonide. Once injected into the vitreous (the gel-like substance that fills the back of the eye), the implant releases very small amounts of the corticosteroid at a controlled rate over approximately three years. This sustained, low-dose delivery is what sets Iluvien apart from other intravitreal corticosteroid treatments.
Fluocinolone acetonide belongs to a group of medicines called corticosteroids (also known as glucocorticoids). These synthetic hormones are powerful anti-inflammatory agents that work by inhibiting the enzyme phospholipase A2, which in turn reduces the production of inflammatory mediators such as prostaglandins, leukotrienes, and cytokines. In the context of retinal disease, this anti-inflammatory action reduces vascular permeability, decreases fluid leakage into the macula, and suppresses the inflammatory cascade that contributes to tissue damage.
Diabetic Macular Edema (DME)
Iluvien is primarily used to treat vision loss caused by chronic diabetic macular edema (DME) when other available treatments have been insufficient. Diabetic macular edema is a complication of diabetes mellitus that occurs when damaged blood vessels in the retina leak fluid and protein into the macula – the central part of the retina responsible for sharp, detailed vision. This leakage causes the macula to swell (edema), leading to blurred or distorted central vision and, if left untreated, permanent vision loss.
DME is the leading cause of vision loss in people with diabetic retinopathy and affects an estimated 7.5% of all diabetic patients worldwide. The condition is particularly prevalent in patients with long-standing diabetes, poor blood sugar control, high blood pressure, or elevated cholesterol levels. Traditional first-line treatment involves anti-VEGF (vascular endothelial growth factor) injections such as ranibizumab, aflibercept, or bevacizumab, which must be administered repeatedly – often monthly or bimonthly. Iluvien offers an important alternative for patients whose DME does not respond adequately to these anti-VEGF therapies, providing continuous treatment without the burden of frequent injections.
Non-Infectious Posterior Uveitis
Iluvien is also approved for preventing relapse of recurrent non-infectious uveitis affecting the posterior segment of the eye. Posterior uveitis is an inflammatory condition affecting the back of the eye, including the retina, choroid, and vitreous. It can cause floaters (dark spots or lines moving across the visual field), blurred vision, and, if the inflammation damages the macula, significant vision loss. The non-infectious form is typically autoimmune in origin and tends to recur, requiring prolonged anti-inflammatory treatment.
By continuously releasing fluocinolone acetonide into the vitreous, Iluvien provides sustained local anti-inflammatory action that helps prevent inflammatory flare-ups. This can reduce the need for systemic immunosuppressive therapy, which carries its own risks of side effects affecting the entire body.
Iluvien was first approved by the European Medicines Agency (EMA) in 2012 for the treatment of chronic DME and has since received marketing authorisation in numerous countries across Europe, as well as in the United States (FDA-approved in 2014 under the brand name Iluvien). The indication for non-infectious posterior uveitis was added subsequently. Iluvien is manufactured by Alimera Sciences and represents a significant advance in sustained-release ocular drug delivery technology.
What Should You Know Before Receiving Iluvien?
Before receiving Iluvien, inform your ophthalmologist about all your medical conditions, especially any eye infections, glaucoma or elevated intraocular pressure, previous herpes simplex eye infections, and any blood-thinning medications you are taking. Iluvien is contraindicated in patients with pre-existing glaucoma, active eye infections, or allergy to fluocinolone acetonide.
Contraindications
You should not receive Iluvien if any of the following apply to you:
- Allergy to fluocinolone acetonide or any of the other ingredients in the implant (polyvinyl alcohol, polyimide, silicone adhesive)
- Pre-existing glaucoma (elevated intraocular pressure that has already caused damage to the optic nerve) – corticosteroids can further increase eye pressure and worsen glaucomatous damage
- Active or suspected eye infection of any kind, including bacterial, viral, mycobacterial, or fungal infections in or around the eye
- Active herpes simplex keratitis (dendritic keratitis) – corticosteroids can worsen herpes infections of the cornea
- Infectious uveitis – Iluvien should only be used for non-infectious inflammatory conditions
Warnings and Precautions
Talk to your ophthalmologist before receiving Iluvien if you have any of the following:
- Blood-thinning medications (anticoagulants such as warfarin, heparin, or direct oral anticoagulants) – these may increase the risk of bleeding at the injection site
- Previous herpes simplex eye infection (even if currently inactive) – corticosteroids can reactivate dormant herpes virus in the eye
- Previous cataract surgery or aphakia (absence of the natural lens) – there is an increased risk of the implant migrating from the back of the eye to the front
Increased eye pain or discomfort, worsening redness of the eye, light flashes and sudden increase in floaters, partially blocked visual field, blurred or decreased vision, increased sensitivity to light, or any other visual disturbances. These symptoms may indicate serious complications such as endophthalmitis (infection inside the eye), retinal detachment, or implant migration.
The injection procedure itself, although performed under sterile conditions, carries a small risk of complications including endophthalmitis (a serious infection inside the eye), bleeding into the vitreous (vitreous haemorrhage), and retinal detachment. Your ophthalmologist will take every precaution to minimise these risks, including administering antibiotic eye drops before and after the procedure.
Increased intraocular pressure (IOP) is one of the most significant concerns with Iluvien. Corticosteroids are known to raise eye pressure in a substantial proportion of patients, and this effect may develop at any point during the 36-month treatment period. If left untreated, elevated IOP can damage the optic nerve and lead to glaucoma. Your ophthalmologist will monitor your eye pressure at regular intervals – typically within 2 to 7 days after the injection, and then at least every three months throughout the treatment period. Some patients may require IOP-lowering eye drops or, in more severe cases, surgical intervention to control the pressure.
Cataract formation is another very common consequence of intravitreal corticosteroid treatment. In patients who still have their natural lens, the corticosteroid can cause clouding of the lens (cataract), leading to progressive vision deterioration. While this can eventually be treated surgically with cataract extraction and intraocular lens implantation, it is important to understand that your vision may temporarily become as poor as or worse than it was before the Iluvien injection until the cataract surgery is performed. Your ophthalmologist will help determine the optimal timing for any necessary cataract surgery.
Simultaneous treatment of both eyes with Iluvien has not been studied and is not recommended. If both eyes require treatment, your ophthalmologist will plan the procedures separately.
Implant Migration
There is a risk that the Iluvien implant may move from its intended position in the back of the eye to the front. This risk is higher in patients who have previously undergone cataract surgery or who have a defect in the posterior capsule of the lens. Signs of implant migration include distorted vision, visual disturbances, swelling of the corneal surface (corneal edema), or visible changes in the front of the eye. If you notice any of these signs, contact your ophthalmologist immediately.
Pregnancy and Breastfeeding
There is limited experience with the use of Iluvien in pregnant or breastfeeding women, and the potential risks are therefore unknown. Since Iluvien is injected directly into the eye, systemic (whole-body) exposure to fluocinolone acetonide is minimal. Nevertheless, as a precautionary measure, you should inform your ophthalmologist if you are pregnant, think you may be pregnant, are planning to become pregnant, or are breastfeeding before receiving this treatment.
There are no available data regarding the effects of Iluvien on fertility. Given the localised intravitreal delivery and negligible systemic absorption, significant effects on male or female fertility are considered unlikely.
Children and Adolescents
The use of Iluvien in children and adolescents under 18 years of age has not been studied and is therefore not recommended in this age group. There is insufficient evidence regarding the safety and efficacy of intravitreal fluocinolone acetonide implants in paediatric patients.
Driving and Operating Machinery
After the Iluvien injection procedure, you may experience temporary blurred vision. If this occurs, you should not drive or operate machinery until the blurriness has completely resolved. You are personally responsible for assessing whether you are fit to drive or perform tasks requiring alertness. Your ophthalmologist can advise you on when it is safe to resume these activities.
How Does Iluvien Interact with Other Drugs?
Because Iluvien delivers fluocinolone acetonide directly into the eye with negligible systemic absorption, significant drug-drug interactions with oral or intravenous medications are uncommon. However, it is important to inform your ophthalmologist about all medications you are taking, particularly blood thinners, other ocular treatments, and systemic corticosteroids.
Unlike oral or intravenous corticosteroids, Iluvien releases its active ingredient locally within the eye. The amount of fluocinolone acetonide that reaches the systemic circulation is extremely small – well below the threshold that would typically cause systemic drug interactions. Nonetheless, certain considerations apply, particularly regarding medications that affect blood clotting and other ocular treatments that may be used concurrently.
Clinically Relevant Considerations
| Drug / Drug Class | Category | Effect / Concern | Recommendation |
|---|---|---|---|
| Warfarin, heparin, DOACs | Anticoagulants | Increased risk of vitreous or subconjunctival haemorrhage during the injection procedure | Inform your ophthalmologist; temporary interruption may be considered on a case-by-case basis |
| Aspirin, clopidogrel | Antiplatelet agents | May increase bleeding risk at the injection site | Usually continued; discuss with your ophthalmologist and cardiologist |
| Anti-VEGF agents (ranibizumab, aflibercept, bevacizumab) | Intravitreal injections for DME | May be used sequentially; combined local effects are not fully characterised | Your ophthalmologist will determine appropriate timing and sequencing of treatments |
| Topical corticosteroid eye drops | Ocular anti-inflammatories | Additive corticosteroid effect may increase risk of raised IOP and cataract | Use only as directed by your ophthalmologist; regular IOP monitoring |
| IOP-lowering eye drops (timolol, latanoprost, brimonidine) | Glaucoma treatment | May be needed to manage corticosteroid-induced IOP elevation | Use as prescribed; essential for managing Iluvien-related IOP rise |
| Systemic corticosteroids (prednisolone, dexamethasone) | Oral / IV anti-inflammatories | Theoretical additive corticosteroid effects, though systemic absorption from Iluvien is negligible | Inform all treating physicians about your Iluvien implant |
Always tell your ophthalmologist and any other healthcare providers about all medicines you are currently taking or have recently taken, including prescription medicines, over-the-counter medicines, eye drops, and herbal or dietary supplements. While Iluvien has minimal systemic interactions, your complete medication history helps your medical team provide the safest possible care.
What Is the Correct Dosage of Iluvien?
Iluvien is administered as a single intravitreal implant containing 190 micrograms of fluocinolone acetonide. It is not a medicine you take at home – it is injected into the eye by an experienced ophthalmologist in a clinical setting. The implant continuously releases the drug for up to 36 months.
Unlike conventional medicines taken by mouth or as eye drops, Iluvien is a one-time intravitreal injection that does not require daily dosing by the patient. The implant is designed to release fluocinolone acetonide at an initial rate of approximately 0.25 micrograms per day, gradually declining over its 36-month lifespan. This controlled-release mechanism provides sustained therapeutic concentrations of the corticosteroid directly at the site of disease in the retina, while minimising systemic exposure.
Adults
Standard Adult Dosage
Dose: One Iluvien implant (190 micrograms fluocinolone acetonide) per affected eye
Route: Intravitreal injection (into the vitreous cavity of the eye)
Frequency: Single administration; the implant provides sustained drug release for approximately 36 months
Re-treatment (DME only): If the effect of the implant wears off and your ophthalmologist recommends it, an additional implant may be injected into the same eye. Re-treatment for the uveitis indication has not been established.
Administration Procedure
The Iluvien injection is performed by an ophthalmologist experienced in intravitreal injections, under controlled aseptic (sterile) conditions. The procedure typically follows these steps:
- Pre-operative preparation: Your ophthalmologist may prescribe antibiotic eye drops to use before the procedure to reduce the risk of infection
- Anaesthesia: Local anaesthetic drops are applied to the eye, followed by either a cotton applicator soaked in anaesthetic or a subconjunctival injection, to numb the injection site
- Antiseptic preparation: An antiseptic solution is applied to the lower part of the eye and surrounding area, and a sterile speculum is placed to hold the eyelids open
- Injection: The ophthalmologist inserts the applicator needle through the sclera (white of the eye) approximately 4 mm from the corneal edge, in the inferotemporal quadrant (lower outer area of the eye). The implant is released into the vitreous cavity
- Post-injection assessment: The ophthalmologist performs an indirect ophthalmoscopy to verify the correct placement of the implant, checks for adequate retinal blood flow, and assesses for any immediate complications
- Post-operative care: You may be prescribed antibiotic eye drops to use after the procedure. Your ophthalmologist will schedule follow-up appointments to monitor your response to treatment
Children and Adolescents
Paediatric Dosage
Not recommended. The safety and efficacy of Iluvien in patients under 18 years of age have not been established. There are no data available to support a dosage recommendation in this age group.
Elderly Patients
Elderly Dosage
No dose adjustment required. Iluvien is a fixed-dose implant that delivers the same amount of fluocinolone acetonide regardless of age. However, elderly patients may have a higher prevalence of pre-existing cataracts and glaucoma, and should be monitored particularly closely for these complications after implantation.
Monitoring After Implantation
Regular follow-up is essential after receiving Iluvien. Your ophthalmologist will typically schedule monitoring as follows:
- Within 2–7 days: Initial post-injection assessment including biomicroscopy and intraocular pressure measurement (tonometry)
- Every 3 months: Ongoing monitoring for at least 36 months, including visual acuity testing, IOP measurement, slit-lamp examination, and fundus examination
- As needed: Additional visits if symptoms such as pain, redness, visual disturbances, or floaters develop
Because Iluvien is administered by your ophthalmologist in a clinical setting, there is no risk of missing a dose or taking too much. The implant works automatically once it is in place, releasing a consistent amount of medication over its 36-month lifespan. There is no action required from you at home beyond using any prescribed eye drops and attending scheduled follow-up appointments.
What Are the Side Effects of Iluvien?
Like all medicines, Iluvien can cause side effects, although not everyone experiences them. The most common side effects are increased intraocular pressure (eye pressure), cataract formation, and the need for cataract surgery. Serious but less common side effects include endophthalmitis (eye infection), retinal detachment, and glaucoma.
Most side effects associated with Iluvien are related to the corticosteroid action of fluocinolone acetonide in the eye, or to the intravitreal injection procedure itself. It is crucial to attend all scheduled follow-up appointments so that your ophthalmologist can detect and manage side effects early. Below is a summary of reported side effects, organised by frequency.
Very Common
- Increased intraocular pressure (IOP)
- Cataract formation or worsening (clouding of the natural lens)
- Cataract surgery (required to restore vision)
Common
- Glaucoma (optic nerve damage from raised IOP)
- Retinal detachment
- Vitreous haemorrhage (bleeding inside the eye)
- Vitreous floaters (small spots or lines in the visual field)
- Feeling of looking through fog or haze
- Ocular hypotony (decreased eye pressure causing sudden pain and blurred vision)
- Loss of normal visual field
- Eye pain or irritation
- Worsened vision
- Surgical procedure to relieve raised IOP or remove vitreous gel
- Increased protein and cells in the front of the eye (anterior chamber inflammation)
- Foreign body sensation in the eye
- Dry eyes
Uncommon
- Blockage of blood vessels in the retina (retinal vascular occlusion)
- Growth of new blood vessels inside the eye (neovascularisation)
- Scleral ulceration (sore on the white of the eye)
- Changes in the vitreous gel
- Clouding of the lens capsule (posterior capsule opacification)
- Eye redness, itching, or infection
- Scleral thinning (thinning of the white outer layer of the eye)
- Injection-site injury
- Unplanned migration of the implant through the sclera
- Implant migration from the back to the front of the eye
- Corneal edema (swelling of the corneal surface)
- Involuntary eyelid closure (blepharospasm)
- Acute angle-closure glaucoma with severe pain
- Corneal deposits
- Corneal epithelial defect (painful scratch on the eye surface)
- Swollen eyelids
Other Reported Effects
- Headache (the most commonly reported non-visual side effect)
Contact your ophthalmologist or seek emergency medical care immediately if you experience: sudden severe eye pain, rapidly worsening vision, a curtain-like shadow across your visual field (possible retinal detachment), sudden onset of many new floaters with light flashes, or increasing redness and swelling after the injection (possible endophthalmitis). Early treatment of these complications is critical for preserving your vision.
It is important to understand that the risk of elevated intraocular pressure may be higher if your IOP was already above normal before treatment. Your ophthalmologist will carefully assess this risk before recommending Iluvien and will discuss it with you in detail. In some cases, IOP-lowering medications (eye drops) or surgical procedures such as trabeculectomy or minimally invasive glaucoma surgery (MIGS) may be necessary to manage corticosteroid-induced pressure elevation.
In patients with posterior uveitis, a temporary decrease in intraocular pressure may occur within the first few days after injection. This is usually self-limiting and resolves without intervention, but your ophthalmologist will monitor you closely during this period.
How Should Iluvien Be Stored?
Iluvien is stored and handled by your healthcare provider and pharmacy – not by you at home. The product should be kept at temperatures not exceeding 30°C, protected from freezing, and should not be opened until immediately before administration.
As a hospital- and clinic-administered product, the storage of Iluvien is the responsibility of healthcare professionals. However, for informational purposes, the following storage conditions apply:
- Temperature: Store at or below 30°C (86°F)
- Cold protection: Do not refrigerate. Do not freeze
- Packaging: Keep in the sealed tray until immediately before use
- Shelf life: Use before the expiry date printed on the outer carton and inner packaging (marked “EXP”)
- Disposal: After use, the applicator should be disposed of safely in a sharps container. Unused product or waste material should be disposed of in accordance with local regulations
Keep all medicines out of the sight and reach of children. Do not use Iluvien after the expiry date stated on the carton and inner packaging. Medicines should not be disposed of via wastewater or household waste.
What Does Iluvien Contain?
Iluvien contains 190 micrograms of fluocinolone acetonide as the active substance, enclosed in a tiny polyimide tube sealed with silicone adhesive and polyvinyl alcohol. The implant is supplied pre-loaded in a single-use applicator.
Active Ingredient
Fluocinolone acetonide – 190 micrograms per implant. Fluocinolone acetonide is a potent synthetic fluorinated corticosteroid with strong anti-inflammatory properties. It has been used in various medical applications since the 1960s and is well-characterised pharmacologically.
Inactive Ingredients (Excipients)
- Polyvinyl alcohol – used as a matrix material within the implant to control the release rate of fluocinolone acetonide
- Polyimide – the material forming the outer tube of the implant, providing structural integrity
- Silicone adhesive – used to seal one end of the implant tube
Appearance and Packaging
The Iluvien implant is a small, light brown tube measuring approximately 3.5 mm in length and 0.37 mm in diameter. It is pre-loaded into a single-use applicator, which is placed on a polycarbonate tray sealed with a peel-off lid. One sealed tray is supplied per carton, along with the package leaflet. The outside of the tray should not be considered sterile; the applicator inside is sterile and must be handled with sterile gloves.
Alimera Sciences Europe Limited, 77 Sir John Rogerson's Quay, Dublin 2, Ireland. Iluvien is approved within the European Economic Area and is marketed in numerous countries including Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, and the United Kingdom.
Frequently Asked Questions About Iluvien
Iluvien is used to treat vision loss caused by chronic diabetic macular edema (DME) when other available treatments such as anti-VEGF injections have not provided adequate results. It is also approved for preventing relapse of recurrent non-infectious posterior uveitis. The implant continuously releases the corticosteroid fluocinolone acetonide into the eye for up to 36 months, reducing inflammation and swelling in the macula.
The Iluvien implant is designed to release fluocinolone acetonide continuously for approximately 36 months (3 years). The implant itself remains in the eye permanently after injection; it is not removed. If the therapeutic effect diminishes and your ophthalmologist considers it appropriate, a second implant may be administered for diabetic macular edema. This long duration is a key advantage, as it reduces the treatment burden compared to anti-VEGF therapies that typically require injections every 4 to 8 weeks.
The most common side effects are increased intraocular pressure (raised eye pressure) and cataract formation or progression. These are very common, affecting more than 1 in 10 patients. Other common side effects include glaucoma, retinal detachment, vitreous haemorrhage, floaters, blurred vision, and eye pain. Regular monitoring by your ophthalmologist is essential to detect and manage these side effects early.
The Iluvien injection is performed under local anaesthesia, which numbs the eye and surrounding area. Most patients experience minimal pain during the procedure itself. You may feel a slight pressure or brief discomfort as the needle enters the eye, but this is typically very brief. After the anaesthesia wears off, some patients experience mild discomfort, redness, or a gritty sensation in the eye, which usually resolves within a few days. Your ophthalmologist may prescribe pain-relieving or antibiotic eye drops for use after the procedure.
No. Simultaneous injection of Iluvien into both eyes has not been studied and is not recommended. If both eyes require treatment, your ophthalmologist will plan the injections separately, with adequate time between procedures to monitor for complications in each eye independently. This approach allows your medical team to assess how well the first eye responds and to manage any side effects before treating the second eye.
Cataract formation is a very common side effect of Iluvien, particularly in patients who still have their natural lens. Clinical studies have shown that the majority of patients who have not previously had cataract surgery will develop significant lens clouding after receiving the implant. While cataract surgery can effectively restore vision, it is important to be aware that your vision may temporarily worsen before surgery is performed. Your ophthalmologist will help determine the best timing for cataract surgery if it becomes necessary.
References
- European Medicines Agency (EMA). Iluvien – Summary of Product Characteristics (SmPC). Last updated 2024. Available at: ema.europa.eu/en/medicines/human/EPAR/iluvien
- Campochiaro PA, Brown DM, Pearson A, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema. Ophthalmology. 2012;119(10):2125–2132. doi:10.1016/j.ophtha.2012.04.030
- Cunha-Vaz J, Ashton P, Iezzi R, et al. Sustained delivery fluocinolone acetonide vitreous implants: long-term benefit in patients with chronic diabetic macular edema. Ophthalmology. 2014;121(10):1892–1903. doi:10.1016/j.ophtha.2014.04.019
- Pavesio C, Zierhut M, Bairi K, et al. Evaluation of an intravitreal fluocinolone acetonide implant versus standard of care in noninfectious posterior uveitis. Ophthalmology. 2010;117(3):567–575. doi:10.1016/j.ophtha.2009.11.027
- National Institute for Health and Care Excellence (NICE). Technology Appraisal TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy. 2013. Available at: nice.org.uk/guidance/ta301
- American Academy of Ophthalmology (AAO). Preferred Practice Pattern: Diabetic Retinopathy. 2024.
- Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4):185–222. doi:10.1159/000458539
- World Health Organization (WHO). Global report on diabetes. Geneva: WHO; 2024.
- Diabetic Retinopathy Clinical Research Network (DRCR.net). Comparative effectiveness of intravitreal therapies for diabetic macular edema. JAMA Ophthalmology. 2023;141(10):927–936.
- Bailey C, Chakravarthy U, Lotery A, et al. Real-world experience with 0.2 μg/day fluocinolone acetonide intravitreal implant (ILUVIEN) in the United Kingdom. Eye. 2017;31(12):1707–1715. doi:10.1038/eye.2017.125
Medical Editorial Team
This article was written by our specialist medical editorial team and reviewed according to international guidelines from the AAO, EURETINA, NICE, and WHO.