Doctors treat diabetic macular edema (DME) in two ways. First, they tackle what's causing it, like high blood sugar or high blood pressure. Just keeping your levels close to normal can stop eye damage from happening or getting worse.
The next step is to heal your retina. You should see an ophthalmologist or a retina specialist for treatment. What's right for you depends on the type of DME you have.
When you have DME, your body makes too much of a protein called VEGF. This causes blood vessels to grow too quickly, so they're weak and leak blood and fluid into your retina and macula. Anti-VEGF shots block the protein to help stabilize these vessels and prevent new ones from growing.
The main anti-VEGF medicines used in DME:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
Angiopoietin-2 is another protein involved in blood vessel formation. Ang-2 inhibitors help stabilize these fragile new blood vessels so they don't leak. It also makes vessels less sensitive to the effects of VEGF.
VEGF/Ang-2 inhibitors include:
- Faricimab-svoa (Vabysmo)
Your doctor uses a thin needle to place the medicine in the center of your eye. You'll get numbing drops before the shot so you won't feel it.
Most people need one shot a month for the first 4 to 6 months. After that, you'll get fewer and fewer over the next several years. Once your blood vessels stop leaking, you should be able to see better.
If you have 20/50 vision or worse, aflibercept may be a better choice over bevacizumab and ranibizumab..
The medicine faricimab-svoa can inhibit both VEGF and Ang-2 and may have a longer-lasting effect than the other anti-VEGF medicines.
These shots don't help everyone. And you shouldn't get them if you're pregnant; they can harm your baby.
Focal-Grid Macular Laser Surgery
Lasers can seal blood vessels in your retina to help slow leaking and bring down swelling.
If you have DME in both eyes, your doctor will treat one eye at a time, with a few weeks in between. Usually you need just one treatment for each eye.
Your doctor might try a laser along with anti-VEGF shots if the shots alone aren't helping.
These drugs, often called steroids, target inflammation. Your doctor might prescribe steroids to lessen swelling in your retina.
You can get steroids in a shot or with a tiny implant in your eye. The implant releases small doses of medicine slowly, so you won't need a series of shots. Your doctor places it in your eye with a special device. The implant dissolves over time, so you don't need to have it taken out.
Steroids usually don't work as well as anti-VEGF shots, and they can cause other eye problems like cataracts and glaucoma. So they won't be the first treatment your doctor tries.
Doctors sometimes use eyedrops to stop DME from happening before or after you have eye surgery. These medicines are called nonsteroidal anti-inflammatory drugs (NSAIDs) because they fight inflammation, like steroids, but don't have the same side effects.
If you need something to help prevent or ease swelling but can't take steroids (or don't want to), your doctor may prescribe NSAIDs instead.
Photo Credit: Georgiy Datsenko / Getty Images
National Eye Institute: "Facts About Macular Edema," "Facts About Diabetic Eye Disease."
Diabetes Care: "Diabetic Retinopathy: A Position Statement by the American Diabetes Association."
Learn, Track, Share: A Patient Guide to Diabetic Macular Edema, Angiogenesis Foundation, 2013.
Clinical Ophthalmology: "Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1)."
Community Eye Health Journal: "Anti-VEGF drugs in the prevention of blindness."
Canadian Journal of Ophthalmology: "Vitrectomy for diabetic macular edema: a systematic review and meta-analysis."