Diabetic macular edema is the leading cause of significant vision loss in patients with diabetic retinopathy. With the increased prevalence of diabetes, the treatment of diabetic retinopathy has become an increasingly important public health concern. The propensity for poorly controlled diabetes to incur visual changes through the development of macular edema has made the treatment of diabetic macular edema one of the more pressing challenges facing ophthalmologists at this time. It is clear that the pathogenesis of diabetic macular edema remains a complex interaction between the maintenance of blood retinal barrier integrity, the development of vasoactive substances, and the unique interaction between the vitreous and retina at the vitreoretinal interface. As we learn more about these interactions through continued scientific exploration and experimentation, it is likely that we will develop a more sophisticated understanding of the factors that contribute to both the progression of retinopathy and diabetic macular edema. While improving glycemic control and the control of other systemic risk factors remain the most important prognostic factors for the progression of retinopathy, increased understanding of the pathophysiology of diabetic macular edema will allow us to continue to develop new and improved modalities of treatment. While focal and grid laser remain the gold standard for the treatment of diabetic macular edema, the use of intravitreal corticosteroids, anti-VEGF therapy, and vitrectomy remain alternatives to photocoagulation. Continued investigation into these and other alternative modalities used individually or in conjunction with laser will help provide answers regarding which treatment strategies will be employed in the future for the treatment of diabetic macular edema.