Laser photocoagulation is still the best treatment for diabetic macular edema. Diabetic macular edema, or DME, is the most common complication of diabetic retinopathy and it will affect almost everyone with the eye disease.
DME is also known as CSME (clinically significant macular edema). The two terms are exactly the same for our purposes.
This is a retinal photograph of a patient with diabetic macular edema. The white spots and flecks are evidence of chronic swelling of the retina from diabetes. The swelling involves the macula, the most sensitive portion of the retina and causes loss of vision.
The goal of any treatment, laser, steroid injections or anti-VEGF injections is to reduce the swelling. If the swelling improves, it is highly likely the vision improves, too.
Usually, a fluorescein angiogram is performed to demonstrate where the normal retinal blood vessels are leaking. Using the energy of the laser, the areas of leakage are heated and this usually, but not always leads to improvement of the swelling.
Treatment can involve anywhere from a few to dozens of burns…all depending upon the number leaks.
Laser treatment to the center of the macula could lead to a permanent blind spot in the vision and, therefore, is not always the best treatment for every patient. In these types of cases, intraocular injections of anti-VEGF or steroids might be a smarter option.
This is the same retina several months after laser treatment. Note the white spots have all disappeared.
After 4-6 months, I can usually tell if the laser treatment is effective or needs to be augmented (ie. repeated). At times, I’ll know I’ll need to treat with a combination of laser and intraocular injections of Avastin, steroids or even Ozurdex.
The laser treatment for diabetic macular edema is very similar to weeding a garden. It is not a cure, and will have to be repeated.
What Does This Mean?
There are a variety of treatments for diabetic macular edema. Laser treatment is still the standard of care for treating this common condition seen with diabetic retinopathy.
Though we have a variety of effective treatments available, we still don’t have a cure. The best advice remains regular examination and treatment as early as indicated.