How Diabetic Macular Edema Is Treated

Diabetic macular edema (DME) is a severe complication of diabetes that requires immediate diagnosis and treatment to prevent severe or permanent vision loss.

The standard of treatment for diabetic macular edema includes a combination of lifestyle modifications—including strict glycemic control through healthy eating and insulin or some other blood glucose–lowering medication—and intravitreal injections with anti-vascular endothelial growth factor (anti-VEGF) medications and corticosteroids. Laser photocoagulation may also be used if the other treatments are not effective.

This article reviews the various treatment options for DME.

Home Remedies and Lifestyle

Managing your type 1 diabetes or type 2 diabetes—that is, keeping your blood glucose level within a healthy range with a combination of diet, exercise, and medication—is the single most important way to prevent and minimize the development and severity of DME.

Two landmark studies—the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS)—have shown that intensive blood glucose control may result in up to a 25% lower risk of DME. Blood glucose control can prevent the progression of the disease and its most severe complication of vision loss.

As well, managing your cholesterol and blood pressure levels can help further lower your risk of DME. Keeping your blood pressure, blood glucose, and cholesterol within a healthy range also improves kidney function, which is important in the management of DME.

While lifestyle changes may slow the progression of DME, prescription medications and specialist-driven procedures are often necessary to adequately manage DME.

Prescriptions

The protein VEGF is mainly responsible for the loss of integrity of the blood vessel wall due to chronically high blood sugar levels. Medications that block the effect of VEGF on blood vessels have been shown to restore the integrity of the blood-retinal barrier, resolve macular edema, and improve vision.

Therefore, anti-VEGF medications, which block blood vessel growth in the eye, have become a vital treatment for DME. VEGF-blockers include:

• Beovu (brolucizumab)
• Eylea (aflibercept)
• Lucentis (ranibizumab)
• Macugen (pegaptanib sodium)
• Avastin (bevacizumab)
• Vabysmo (faricimab-svoa)

These medications must be injected into the eye (intravitreal injection) by a medical professional. This usually is an ophthalmologist, a medical doctor who specializes in eye and vision care. Numbing medication is administered prior to this often painless procedure and the corticosteroid dexamethasone may be coadministered to increase the efficacy of the treatment.

The typical treatment protocol for intravitreal injections of anti-VEGF medications is one injection per eye every six months. This treatment may be combined with corticosteroids or laser photocoagulation for added benefit. 

Corticosteroid eye drops or injections may be prescribed by your healthcare provider to reduce inflammation in the eye andmake the anti-VEGF treatment more effective. Corticosteroid implants are most commonly prescribed. These include:

• Ozurdex: An extended-release dexamethasone intravitreal implant
• Retisert: An extended-release fluocinolone acetonide intravitreal implant
• Iluvien: A low-dose fluocinolone acetonide intravitreal implant administered over several years

Surgeries and Specialist-Driven Procedures

The below surgeries and specialist-driven procedures are possible treatment options for DME.

Laser Therapy

One of the oldest forms of DME treatment is retinal laser photocoagulation treatment (RLPT).

Laser therapy works by burning the retina and sealing leaky areas of damaged blood vessels in the eye. It has become less popular over the years due to the rise of new anti-VEGF medications.

Vitrectomy

Vitrectomy is a surgical procedure performed by an ophthalmologist that involves removing the vitreous humor (a clear jelly-like substance that fills the inside of the eyeball), thereby increasing oxygen to the eye. It is more commonly used in those with diabetic retinopathy than those with diabetic macular edema. 

While research shows that vitrectomy may improve visual acuity in people with moderate vision loss, it has not been proven to be a more effective therapy than anti-VEGF medications, steroid injections, or RLPT for DME.

However, vitreous surgery may be needed when prior treatments are not effective (refractory cases). Vitrectomy also carries the risk of serious side effects.

Over-the-Counter (OTC) Therapies

Nonsteroidal anti-inflammatory drugs (NSAIDs) and eye drops may be used prophylactically (before) or postoperatively (after) cataract surgery to prevent the development of DME.

Summary

The standard of treatment for DME includes a combination of diabetes management and intravitreal injections with anti-VEGF medications and corticosteroids. Laser photocoagulation may be used if other treatments are not effective. If left untreated, DME can lead to blindness.

A Word From Verywell

The initial symptoms of DME can be nonspecific and subtle, mimicking many other benign (noncancerous) conditions that may affect your vision. Sometimes a diagnosis of DME is made at the same time as a diagnosis of diabetes. No matter the case, if you are experiencing any change in your vision, it is important for you to check in with your healthcare provider.

DME can quickly progress to severe vision loss, especially if your diabetes is not well managed, so a prompt diagnosis and treatment are important to preserving your vision and lessening symptoms. If left untreated, DME can lead to severe or permanent vision loss.