The standard treatment for diabetic macular edema is still laser photocoagulation (laser treatment). The treatment has been utilized for about 30 years, yet newer, and better, treatments are on the horizon. Diabetic macular edema is the biggest, most common, complication of diabetic retinopathy. Most patients with diabetes will develop some degree of this type of retinal swelling.
Recently there have been several reports of new treatments for diabetic macular edema. 3 studies report the advantages of using anti-VEGF medications and a 4th advocates the use of steroids for treating diabetic retinal swelling.
Both Lucentis and Avastin are now acceptable treatments for wet macular degeneration. Both are anti-VEGF medications.
It seems that anti-VEGF treatmentst may be effective against macular swelling, too. Separate reports emerged from the 2010 World Ophthalmic Congress that described significantly better results for both Lucentis and Macugen when compared to laser treatment alone.
Both Macugen and Lucentis treatments resulted in better vision when compared to laser treatment alone. Neither is yet FDA approved for diabetic eye treatment.
This, too, is another anti-VEGF medication. As with its cousins, Lucentis, Avastin and Macugen, it is delivered as an injection (although the name is quite confusing) into the eye.
Preliminary results in an ongoing study indicate that VEGF Trap-Eye is also an effective treatment for diabetic macular edema. This study (DA Vinci Study) is ongoing. Results from its Phase II study were reported.
Ozurdex is FDA approved for retinal vein occlusions. It is a sustained release drug delivery system that, when injected into the eye, will release steroids for 4-6 months.
Early results indicate that this treatment, too, may be useful for treatment of diabetic macular edema.
What Does This Mean? Just remember that anti-VEGF medications are likely to be used to treat diabetic macular edema in the near future. 3 reports, all the same class of drugs (i.e. anti-VEGF), getting better results when compared to laser treatment.
Retina doctors have been using anti-VEGF medications and steroids for the past few years to treat patients who are not treatable with laser, or, patients in whom laser hasn’t worked. These studies are confirming what we are noticing in our offices; anti-VEGF works in diabetes.
The same is true for Ozurdex. We have long noted improvement in our patients “resistant” to laser treatment. Intraocular injections of steroids often improves the vision in diabetic patients. It is not a long shot to believe that a long-acting, sustained drug delivery system would do the same.
All of this is on the horizon. None of these drugs are FDA approved for diabetic macular edema…yet.