Being diagnosed with diabetic macular edema (DME) can leave you feeling stressed and uncertain about what to do next. A great first step in taking control of your DME is understanding the treatment options available to you. There are three main types of treatments, namely anti-VEGF (anti-Vascular Endothelial Growth Factor), corticosteroid, and laser treatments, that each come with their own benefits and considerations.
When it’s time to make a decision about preserving your retinal health, you should work with your retina specialist to find the best course of treatment for you. Everyone’s DME journey is unique. So, let’s explore these three types of DME treatment options so you can feel comfortable having the discussion with your provider and, ultimately, select the right choice for your situation.
Anti-VEGF therapy has emerged as the most common treatment for DME. This class of drugs works by blocking or slowing down the development of new blood vessels and limiting leakage from existing ones.
Anti-VEGF drugs treat DME by inhibiting the action of VEGF, a protein responsible for abnormal blood vessel growth. By effectively suppressing VEGF, anti-VEGF drugs can help stabilize and even improve the condition of the macula, leading to better visual outcomes.1
One of the main challenges with anti-VEGF treatment is the frequency of injections necessary to manage DME. Due to the short duration of action of these drugs, regular administration is required to achieve and maintain effective treatment. Anti-VEGF drugs usually involve monthly or every other month injections directly into the eye. Although they may cause some discomfort, the procedure is relatively quick, straightforward and an in-office procedure. The injections can allow for minimal disruption to your daily life, as you can usually resume regular activities shortly after the injection.
Corticosteroid therapy is another option to consider if you’re looking for longer-lasting treatment. There are two corticosteroid drugs that are FDA approved for reducing DME and improving vision. These drugs work by targeting the inflammation and swelling in the retina, which are the underlying causes of DME. Treatment of DME with corticosteroids can be done in two ways.
The first option involves injecting a short-acting corticosteroid drug every few months. This approach provides a targeted, longer-lasting effect with less frequent injections compared to anti-VEGF injections. The second option for corticosteroid treatment is designed to consistently and continuously release a low dose of the drug for an extended period, up to 36 months, with a single injection. This approach reduces the need for repeated injections by providing a sustained therapeutic effect over a longer period of time. This can be a great option for DME patients who are injection-averse and prefer fewer visits to the eye doctor.
One potential challenge to the use of corticosteroids is an accelerated development of cataracts. Another possible challenge is that some patients may experience an increase in intraocular pressure as a result of treatment. It is important to maintain regular appointments so that your physician can monitor any reactions to treatment and provide additional treatment as necessary.
Laser photocoagulation treatments commonly involve directing a laser into the back of the eye to cauterize leaking blood vessels in the retina. By precisely targeting and sealing off the leaking blood vessels, laser photocoagulation can help stabilize the retina and prevent further damage.
Unlike anti-VEGF or corticosteroid treatments that require regular injections, laser treatment can sometimes be completed in a single session; however, it may not be suitable for all types of DME patients. The effectiveness of laser photocoagulation depends on the specific characteristics of the condition, such as the location and severeness of the leaking blood vessels.
Additionally, certain factors, such as the amount of significant macular edema or proximity to the fovea (the central part of the macula responsible for sharp vision), may affect the suitability of laser treatment. You should also keep in mind that the laser energy used during the procedure could lead to scarring or damage to surrounding healthy tissue, which may impact your peripheral or night vision.
Choosing the right DME treatment for you can be downright overwhelming when weighing all the different options and procedures. Just remember that your eye doctor is an expert in the field with the knowledge, experience, and understanding of your unique eye health to make informed recommendations.
By asking several questions and performing a full eye exam or other tests, your eye doctor will be able to properly diagnose your condition and provide guidance on the most appropriate treatment for you. Together with your doctor, you can navigate the options and make the best decision to manage your DME and preserve your beautiful vision!