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Medically reviewed and verified by Kate Burke, MD, MHA
Diabetic macular edema (DME) is a severe complication of diabetic retinopathy (DR) that affects the retina. If untreated it can lead to vision impairment or even blindness. This condition happens when there is swelling in the macula caused by leaky blood vessels. Blood vessels leak because of prolonged high blood sugar levels. About 3.8% of people with diabetes in the United States are affected by DME, making it a significant concern for diabetic patients. If you or someone you know has been diagnosed with DME, understanding the treatment options and managing the condition effectively is important. Here is a guide from PatientsLikeMe!
Diagnosing DME
If you read about how DME develops you may see it referred to as "insidious." In this context, what that means is that people are often unaware they have the condition for years! It isn't until it progresses far enough to impact vision that you may realize there is an issue. This means regular eye examinations are a key part of early detection. People with diabetes should have comprehensive eye exams that include retinal imaging, such as optical coherence tomography (OCT), to find changes in the retina. OCT can identify swelling, structural changes, and fluid buildup in the macula. Early screening gives you the chance for intervention to prevent severe vision loss.
Treating DME
If you have recently been diagnosed with DME, what are your treatment options? There are a few! Regardless of what route you and your doctor go down, there are a few things you should always keep in mind. The first is to seek care from a specialist. Whether an ophthalmologist or retina specialist, they can help you understand and manage DME more effectively. Make sure you discuss the benefits and risks of each treatment option with your doctor. Follow up visits are essential to track your progress. With that in mind, here are the most common treatment options.
Anti-VEGF Therapy
Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for DME. VEGF is a protein that promotes the growth of abnormal blood vessels, which are prone to leaking. Anti-VEGF medications block this protein. This in turn reduces swelling and prevents further damage. Commonly used anti-VEGF drugs include:
- Aflibercept (Eylea)
- Ranibizumab (Lucentis)
- Bevacizumab (Avastin)
- Faricimab (Vabysmo)
Anti-VEGF medications are given as intravitreal injections, directly into the eye. First, most patients need monthly injections for 4–6 months, followed by a reduced frequency based on how they respond. While they are generally safe, there are some risks! They include mild discomfort, bleeding at the injection site, and a rare risk of eye infection. People who are pregnant should avoid anti-VEGF treatments because of the potential harm to the fetus.
Corticosteroids
If anti-VEGF therapy does not work, doctors may turn to corticosteroids. These drugs target inflammation, which plays a role in DME. Corticosteroids are delivered through injections or sustained-release implants. Corticosteroids can lower retinal swelling and may be effective for patients who don't respond to anti-VEGF therapy. Potential side effects include increased intraocular pressure, cataract formation, and worsening vision in some cases. If you are on corticosteroids, you will need regular monitoring by an ophthalmologist.
Focal-Grid Laser Therapy
Before researchers developed anti-VEGF therapy, laser photocoagulation was the standard treatment for DME. It is now used as an adjunct treatment for persistent cases. In focal-grid laser therapy, a laser is used to seal leaking blood vessels and stabilize the retina. The treatment focuses on specific areas of leakage while saving healthy retinal tissue. While laser therapy can lower swelling and prevent further vision loss, it does not typically improve vision like anti-VEGF therapy can. The procedure is generally safe, but some patients may experience temporary vision changes or a loss of peripheral vision.
DME is a serious condition, but with advances in medical treatments like anti-VEGF therapy, corticosteroids, and laser photocoagulation, patients have more options than ever before. Early detection, proper management, and lifestyle adjustments can make a significant difference in preserving vision and improving quality of life for those living with DME. If you have been diagnosed with DME, don’t hesitate to discuss your options with your healthcare provider and take proactive steps to protect your vision.
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