Are you struggling with vision changes possibly due to diabetes? 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 health care provider and ophthalmologist (eye disease specialist) to find the best treatment plan for you. If left untreated, DME can cause vision problems and possibly even vision loss in severe cases.

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.

What Is Diabetic Macular Edema?

Diabetes is a chronic (long-term) condition in which your body has trouble using blood glucose (blood sugar) for energy. As a result, your blood sugar levels rise. When blood sugar remains elevated for a long time, it can cause serious damage to many of your organs, including your eyes.

High blood sugar and diabetes can damage the light-sensitive tissue in the back of your eyes, known as the retina. Over time, this can lead to a 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.

Diabetic macular edema can cause blurry, double, or wavy vision or floaters.

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, known as 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.

Treatments for Diabetic Macular Edema

DME treatments focus on lowering your blood sugar levels, controlling inflammation, and targeting leaky blood vessels. Your doctor will choose the best course of treatment based 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.

1. Lifestyle Changes

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 current diabetes care plan to control your blood sugar levels and discuss any changes with your doctor. Try to:

• Take your insulin or other diabetic medications as prescribed by your doctor.
• Eat a healthy diet.
• Exercise regularly.
• Manage stress.

High blood sugar levels from poorly controlled diabetes could worsen your DME symptoms. These lifestyle changes can also help reduce hypertension (high blood pressure), another cause of DME.

2. Anti-VEGF Injections and Therapies

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. Although new blood vessels are important for healing, these vessels are leaky and promote blood buildup in your retina and macula.

Anti-VEGF therapies block proteins that create new, abnormal blood vessels to stabilize your diabetic macular edema.

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:

• Aflibercept (Eylea) and aflibercept biosimilars including Enzeevu, Ahzantive, Yesafili, and Opuviz — Biosimilars are safe, effective, and high-quality versions of biologic drugs.
• Brolucizumab-dbll (Beovu)
• Faricimab-svoa (Vabysmo)
• Ranibizumab (Byooviz) and its biosimilars including Cimerli, Lucentis, and Susvimo

Bevacizumab (Avastin) was originally approved to treat cancer, though some doctors prescribe it “off-label” — that is, outside its FDA-approved use — for treating DME.

Also called intravitreal injections, these treatments are injected into the vitreous, which is 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.

One DiabetesTeam member shared their experience with injection treatment in their eye: “It’s daunting. I often have to hold my nerve and keep calm about things.”

3. Medications To Control Inflammation

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

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 (sold under brands including Kenalog and 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, which is nerve damage in your eyes, or cataracts, the clouding of your eyes.

NSAIDs

NSAID eyedrops 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. Brands of NSAID eyedrops you may use include:

• Bromfenac (BromSite, Prolensa)
• Diclofenac (Voltaren)
• Ketorolac (Acular, Acuvail)
• Nepafenac (Nevanac)

4. Surgical Procedures

If medications and lifestyle changes don’t improve your DME symptoms, your eye specialist may recommend a surgical procedure. Depending on your symptoms, there are two main types of surgery for DME: laser treatment and vitrectomy.

Laser Treatment

Focal, or grid, laser treatment, also known as laser photocoagulation surgery, seals off leakages in your 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.

Vitrectomy

Your eye specialist may instead recommend 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.

If you’re living with diabetes, it’s important to see your eye specialist every year to check your eye health.

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.

Talk With Your Eye Specialist About DME

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 without early treatment.

Be sure to make an appointment with your eye specialist if you notice any changes in your vision, such as:

• Blurry or double vision
• Dark areas in your vision
• Trouble reading or seeing details
• Spots floating in your vision

Your doctor will perform an eye exam and may include 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.

Find Your Team

On DiabetesTeam, the social network for people with diabetes and their loved ones, more than 158,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Are you living with diabetic macular edema? What treatments have helped you? Share your questions in the comments below, or start a conversation by posting on your Activities page.