Any individual with diabetes is at risk for developing diabetic macular edema (DME). This condition leads to the accumulation of fluid in central retina (macula) due to damaged blood vessels which then causes blurry vision. Diabetic macular edema impacts more than 560,000 Americans and according to the U.S. Centers for Disease Control (CDC) and it is the leading cause of blindness in adults 20 to 74 years of age in the United States.
Can it be helped?
The most important treatment for diabetic retinopathy and diabetic macular edema is prevention. This can be achieved through tight blood sugar control and management of other medical conditions like hypertension and hypercholesterolemia. Optimization of these conditions is essential in prevention as well as maintaining stability and keeping visual gains achieved through treatments provided by your retina specialist.
Treatments options for diabetic macular edema include LASER, intravitreal anti-vascular edothelial growth factor (VEGF) injections, and corticosteroid injections. LASER treatment targets the damaged blood vessels directly seeking to reduce the area and amount of leakage. LASER helps stabilize vision and can prevent vision loss, but rarely improve visual acuity. Intravitreal anti-VEGF injections (Lucentis, Avastin, Eylea) are medicines injected directly into the eye which, target the proteins (VEGF) that stimulate the leaky vessels in the retina. By blocking these proteins retina specialists can stabilize and often reverse some vision loss. Corticosteroids are anti-inflammatory and can inhibit the mechanisms that cause inflammation within blood vessels, which lead to diabetic macular edema. They can also stabilize and often reverse some vision loss, and can be injected directly onto the eye for maximal potency.
New Treatment Options
In September 2014, the FDA approved two new treatment options for use in diabetic macular edema: Ozurdex and Iluvien. Both are steroid implants, which are injected into eye. This procedure is done in the office with a small needle that creates a self-sealing incision. Each implant allows for a slow, sustained release of steroid over an extended period of time. Ozurdex releases the steroid dexamethasone and can last up to 6 months, while Iluvien delivers fluocinolone acetonide and can last up to 36 months. Compared to other therapies, steroid implants may allow for superior treatment of more recalcitrant cases and less frequent dosing. Risks associated with intraocular steroid treatment include steroid-induced cataracts, and increased intraocular pressure, which is a risk factor for glaucoma.
Treatment choices have continued to evolve, and several excellent options are available for the treatment of diabetic macular edema. Depending on the individual, these treatments can be used alone, in combination, or in succession with the goal of maintaining the best visual acuity possible.
Contact your retina specialist with questions, or call our office to arrange a consultation with one of our retina physicians to help better understand and treat your diabetic retinopathy.