ANDREW HENDRICK: When we first
with diabetic macular edema,
I set forth the goals
that my hope is that we can help
them improve vision.
And we can do that
for a vast majority of patients.
Nowadays, the standard of care
for our patients
that have diabetic macular edema
involves medicines that are
injected into the eye in order
to help them recover
as much vision as possible.
Once we see patients
with diabetic macular edema,
the average patient is going
to need treatment
for around a year.
Many patients need
ongoing treatment, even
beyond that year,
but the treatment burden
is often reduced.
Side-effects of medicines that
are injected into the eye
usually include some redness
and irritation for about a day
of the treatment.
The most worrisome
include, blinding complications,
including things like infections
in the eye
or retinal detachment.
How we best help patients who
have diabetic macular edema
is with regular treatment.
It is a actively engaged patient
that is going to have the best
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 stop this from happening.
There are three anti-VEGF medicines used in DME:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
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 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.
All the medicines work about the same if you have 20/40 vision. If you have 20/50 vision, aflibercept may be a better choice.
Anti-VEGF 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. And it dissolves over time, so you don't need to have the implant 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.
NSAID Eye Drops
Doctors sometimes use eye drops 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.