OBJECTIVES: To understand the barriers that may prevent Australian patients with diabetic macular edema (DME) from adhering to intravitreal injection therapy. METHODS: Patients who had received intravitreal treatment for DME completed a patient diary to quantify the treatment burden relating to diabetes and DME. This was followed by an interviewer administered questionnaire for the qualitative assessment of treatment barriers.   RESULTS: Patients were aged from 34-72 years and had DME for between 8 months to 5 years. The key barriers to intravitreal treatment adherence is the frequency and travel time to appointments for their DME treatment, especially as patients face a high volume of other medical appointments for their diabetes and related co-morbidities (e.g., hypertension, cardiovascular and kidney disease). The number of medical appointments in a typical year ranged from 13-42 appointments, while the median travel time to their appointments for DME treatment is 1.3 hours each wayPatients living in rural areas of Australia have a much longer travelling time. In addition, patients need up to a day of recovery after an intravitreal injection, which results in worktime loss in employed patients, as well as family members, who patients rely heavily on to get them to and from injection appointments. All patients also admitted they felt slightly anxious on the day of each intravitreal injection. The most desired improvement in this cohort of patients was a reduction in the number of intravitreal injections. CONCLUSIONS: DME patients experience a high treatment burden due to diabetes and related co-morbidities. Consequently, intravitreal DME treatment options that have a lower frequency of treatment could contribute to improved patient satisfaction and adherence.