OBJECTIVES:  To study real-life patient characteristics, treatment patterns and costs associated with DME and visual acuity (VA) level.  METHODS:  The study aimed to recruit 100 patients distributed evenly over 4 categories defined by last measured VA. 1-year retrospective data were collected from medical records. Annual direct costs were calculated from resource use in medical records and official unit costs (€ 2011). Self-reported economic burden was collected via Short Form Health and Labour Questionnaire (SF-HLQ). Indirect costs (€ 2011) included personal expenses and caregiver burden (SF-HLQ). RESULTS:  Thirteen Belgian ophthalmologists recruited 32, 12, 14 and 6 DME patients for VA categories ≥20/50, 20/63-20/160, 20/200-20/400 and <20/400 respectively. VA was stable during the study in 86% of patients. Recruitment for lower VA categories was difficult due to long-term vision conservation with current treatments, lack of differentiation between lowest categories in medical records and discontinuation of ophthalmologist care in lowest categories. 75% of patients had bilateral DME. 68% were treated for DME during the study, of which 60% in both eyes. 50% received photocoagulation, 33% intravitreal drugs. Less than 4% of patients had paid work; 17% received disability replacement income. Total direct medical costs in patients receiving active treatment ranged from €960 (lowest VA) to €3,058. 59% of direct costs were due to monitoring and vision support, 39% to DME treatment. Indirect cost trends were less intuitive due to small samples and large variations. Annual costs grouped by 2 highest and 2 lowest VA levels, were respectively €114 and €312 for visual aids, €407 and €3,854 for home care. CONCLUSIONS:  The majority of DME patients had bilateral disease. Except for the lowest VA, direct medical costs increased with VA decrease. Indirect costs were substantially higher at lower VA levels. Low sample sizes in some categories did not allow statistical analysis of cost differences.