If you’re living with diabetic macular edema (DME) and type 1 or type 2 diabetes (diabetes mellitus), you might be wondering what your treatment options are. It’s important to work together with your doctor and ophthalmologist (an eye-disease specialist) to find the best treatment plan for you. Left untreated, DME can result in vision problems and — in severe cases — vision loss.
In this article, we’ll cover the four main types of DME treatments, including lifestyle changes, medications, and medical procedures. Be sure to talk to your doctor and eye specialist if you have any questions after reading this article.
Diabetes is a long-term (chronic) condition in which your body has trouble using sugar — specifically glucose — for energy. As a result, your blood sugar levels rise. Persistently high blood sugar in diabetes can cause serious damage to many of your organs, including your eyes.
Diabetes can damage the light-sensitive tissue in the back of your eyes known as the retina, causing an eye condition called diabetic retinopathy. In diabetic retinopathy, high blood sugar levels progressively damage the delicate blood vessels in your retina. These blood vessels develop tiny bulges known as microaneurysms.
Over time, these microaneurysms can leak blood and other fluids into the retina, causing DME. The macula is the center part of the retina, which helps you see clear, sharp details, colors, and objects that are far away and in front of you (central vision). If you have DME, swelling of the macula from the leaking blood and fluid may give you blurry, double, or wavy vision or floaters (shadowy specks moving in the eye). If left untreated, this diabetic eye disease can lead to more serious complications like vision loss.
DME treatments focus on lowering your blood sugar levels, controlling inflammation, and targeting leaky blood vessels. The treatment your doctor chooses will depend on the type of DME you have and the severity of your symptoms. You may need more than one treatment to get your symptoms under control.
Since DME is caused by high blood sugar levels from diabetes, your doctor will likely encourage you to make some lifestyle changes. Not only will these changes help control your DME, but they can also help you live a healthier life with diabetes.
Be sure to stick to your diabetes care plan to control your blood sugar levels — whether that’s taking insulin or other diabetic medications, eating a healthy diet, or exercising regularly. High blood sugar levels from poorly controlled diabetes can worsen your DME symptoms. These lifestyle changes can also help reduce hypertension (high blood pressure), another cause of DME.
In DME, high blood sugar levels cause your eyes to form a type of protein called vascular endothelial growth factor (VEGF). This protein is responsible for causing new, abnormal blood vessel growth in the retina. While new blood vessels are important for healing, these vessels are leaky and promote blood buildup in your retina and macula.
Anti-VEGF therapies block these proteins from creating new blood vessels to stabilize your DME. These treatments are often the first option doctors choose. The U.S. Food and Drug Administration (FDA) has approved several anti-VEGF therapies for DME:
Bevacizumab (Avastin) was originally approved to treat cancer — however, some doctors prescribe it “off-label” — that is, outside its FDA-approved use.
Called intravitreal injections, these treatments are injected into the vitreous or the gel-like substance in the whites of your eyes. Your ophthalmologist will numb your eye and use a very thin needle to deliver the medication. Most people’s vision stabilizes with anti-VEGF treatment — meaning it doesn’t get any worse. Around 30 percent of people even see an improvement.
High blood sugar from diabetes can also cause inflammation in your eyes, leading to DME. By controlling this inflammation, your ophthalmologist can reduce swelling in your retina. Two types of anti-inflammatory medications for treating DME include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs).
Corticosteroids (steroids) are often used as a last-resort treatment option for DME when other therapies have failed. Your eye specialist may inject the corticosteroid directly or insert an implant that slowly releases a steady dose of the drug.
Dexamethasone (Ozurdex) and fluocinolone acetonide (Iluvien) are FDA-approved steroid implants. Triamcinolone acetonide (Kenalog, Triesence) can be used off-label alone or together with laser surgery to treat DME. It’s injected into the vitreous of your eye, similarly to anti-VEGF therapies.
When you’re undergoing steroid treatment, your eye specialist will have you in for regular visits. This is because corticosteroids may have unwanted side effects like glaucoma (nerve damage in your eyes) and cataracts (clouding of your eyes).
NSAID eye drops are another anti-inflammatory treatment for DME. Your eye specialist may prescribe them to help reduce swelling in your retinas before or after eye surgery. There currently aren’t many studies showing how effective NSAIDs are for DME, so more research is needed in the future. Examples of NSAID eye drops you may use include:
If medications and lifestyle changes don’t improve your DME symptoms, your eye specialist may recommend a surgical procedure.
Focal, or grid, laser treatment — also known as laser photocoagulation surgery — seals off leaky blood vessels with a laser. This focused beam of light creates heat that burns the vessels. While focal laser therapy can’t improve blurry vision, it can prevent it from worsening.
Another surgical treatment your eye specialist may recommend is a vitrectomy. Some people with DME can have cloudy vitreous fluid or scar tissue interfering with their vision. A vitrectomy removes the fluid and tissue — according to the American Academy of Ophthalmology, this procedure can prevent your vision from getting worse or even improve it.
During this procedure, your specialist will create tiny holes in your eye using a specialized instrument. They’ll remove the vitreous and any scar tissue, then — as necessary — may fix any hole in your retina or place a bubble of air or another type of gas inside the eye to keep your retina properly positioned.
If you’re living with diabetes, it’s important to see your eye specialist every year to check your eye health. Diabetes-related eye diseases like DME can cause vision impairment or permanent vision loss if they’re not addressed early.
Be sure to make an appointment with your eye specialist if you begin noticing any new changes in your vision, including blurry or double vision. They’ll perform an eye exam and perhaps additional testing like optical coherence tomography and fluorescein angiography to check your retinas. If you’re diagnosed with DME, they’ll create a treatment plan to prevent vision loss. It is important to stick to the treatment plan as instructed since DME may take some time to resolve
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