Dear Editor, The approval of intravitreal injections of ranibizumab for the management of diabetic macular edema (DME) has induced a dramatical shift in the therapeutic approach of this entity, as the major clinical trials have proven the significant benefit of this treatment for patients with center-involving DME [1–3]. As a consequence, the classification of DME needs to be updated so that a useful correlation between grading and therapeutic indication could be assumed. Nowadays, the key feature of DME is the involvement or sparing of the fovea. Whenever DME involves the fovea, a clear indication for treatment with ranibizumab seems reasonable on the basis of the results reported by the major pivotal clinical trials. However, if the fovea is spared, laser photocoagulation might be indicated. Together with this, the continuous evolution of optical coherence tomography (OCT) systems makes it possible to precisely analyze qualitatively and quantitatively cases of DME, but also to have topographical information. Given the high accuracy of the topograhical thickness maps provided by the OCT devices, one might easily recognize just by taking a quick look at them the presence or abscence of foveal involvement, therefore making the decision on whether intravitreal injections of ranibizumab would be clearly indicated (foveal involvement) or not (foveal sparing). Furthermore, the morphometric and topographical analysis of DME should be considered as dynamic information, as every treatment might induce changes in thickness but also in the topograhy of the retinal thickenning. Again, at any point through the evolution of a single case of DME, by considering the foveal involvement or sparing, further therapeutic considerations could be easily undertaken. The burden of continuous follow-up visits and treatments required by patients with DME makes necessary to simplify the analysis of the macular thickening and the treatment decision. Fluorescein angiography (FA) provides valuable information about the status of the retinal circulation, and exclusive information about retinal ischemia, highlighting areas of retinal neovascularization. However, most of the findings shown on the FA images might not change the therapeutic consideration of the majority of cases with DME. Also, a good correlation between the leakage area evidenced on FA and the retinal thickening pattern shown by the retinal thickness map provided by the OCT has previously been reported [3–6]. Finally, FA is an invasive and timeconsuming technique. Thus, the treatment decision could be established by analyzing the retinal thickness maps provided by the OCT. Previous OCT classifications have focused on qualitative parameters [7], but not considered the topographical distribution and the involvement of the fovea. Herein (see Fig.1) we propose a simplified classification and grading of DME based on the OCT topographic findings that may be of great value for the physicians in order to make the choice of the most appropriate therapy for each eye of each patient presenting with DME to the daily practice. First, the location of the macular thickening should be topographically analyzed and classified into: central (involvement of the foveal ETDRS sector by macular thickening); peripheral (involvement of juxtafoveal ETDRS sectors with sparing of the foveal sector); marginal (involvement of extrafoveal ETDRS sectors with sparing of the juxtafoveal and foveal sectors). Secondly, the extent of the macular thickening should be stratified according to the total number of areas of the ETDRS grid occupied by retinal thickening (1 if the number of sectors involved is 1 to 3; 2 if it is 4 to 6; and 3 if it is 7 to 9). Finally, the presence of vitreofoveal traction should be considered (present or absent). R. Dolz-Marco : R. Gallego-Pinazo (*) Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, Bulevar Sur, s/n, Valencia 46026, Spain e-mail: robertogallegopinazo@gmail.com