New Treatments for Diabetic Macular Edema | Diabetic Retinopathy

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New Treatments for Diabetic Macular Edema | Diabetic Retinopathy

Intraocular Injection, Randall V. Wong, M.D., Retina Specialist, Fairfax, Virginia

The treatment for diabetic macular edema has changed.  The gold-standard for treatment of diabetic macular edema has long been laser treatment, but several types of injections have become approved.

Over the past few years, I have written many articles about various new ways to treat DME.  Here’s a review of the most current ways to treat this common complication of diabetic retinopathy.

Laser Photocoagulation

This has been the “gold-standard” for treatment, that is, this is the treatment by which all others have been compared.  Laser photocoagulation, or laser treatment, was first used in the late 1970’s and was the first treatment for diabetic retinopathy.

Laser treatment works best when there are easily defined areas of leakage and the “leaks” are easy to see by fluorescein angiography.

Laser treatment works less well when there is diffuse thickening, but without obvious focal areas of leakage.  Laser treatment can not be performed when the areas requiring treatment are located in the central macula.

anti-VEGF (Avastin, Lucentis, Eylea)

These are a group of drugs which work very similar to each other.  The are known as anti-VEGF drugs because they block the effects of Vascular Endothelial Growth Factor.  VEGF is implicated in many types of retinal swelling and also in wet macular degeneration.

VEGF causes abnormal retinal vessels to leak.

Both Lucentis and Eylea are FDA approved for treating diabetic macular edema.

Ozurdex

Intraocular steroids, such as Kenalog, have been injected into the vitreous to help control diabetic macular edema.

Ozurdex, a sustained release steroid delivery system, has also been FDA approved for the treatment of diabetic macular edema in those who have had cataract surgery or are planning to have cataract surgery.

The device is delivered into the vitreous as an injection and steroid is released into the eye for about 4 months.

What Does this Mean?

With the approval of these newer products, laser treatment is no longer the gold standard for treating macular edema from diabetes.

In addition, we have several methods by which we can “treat” complicated cases, or cases where the swelling is stubborn and doesn’t leave.

There still is a role for each treatment modality.  No single treatment seems to be better than another.  It has become customary, at least in my practice, to usually combine treatments for the best outcomes!

Despite the array of treatments, it is still prudent to get early and regular dilated eye exams to limit the development of DME.

 

Comments
  • Preeti Raheja August 26, 2014 at 1:40 pm

    Doctor my father is a patient of DME and glaucoma he has a shunt in both eyes hence would like to now if there are any devices for people like him since he has lost his right eye and left eye he has very low vision so that he can go about reading the newspaper etc and livr a normal life and go about his dalit activities…..please let me know at the earliest and oblige…..Regards Preeti Raheja

    • Randall V. Wong, M.D. September 2, 2014 at 9:23 am

      Preeti,

      First, I’d make sure the DME is completely treated. If so, then find the services of a “low vision specialist.”

      There are devices which may improve function despite poor vision.

      Randy

  • Preeti Raheja August 26, 2014 at 1:43 pm

    He has also injected his eye with lucentis, avistin and ozurdex

  • Preeti Raheja August 26, 2014 at 1:44 pm

    Would also like to know when stem cell therapy will come…

    • Randall V. Wong, M.D. September 2, 2014 at 9:27 am

      Preeti,

      Not likely for DME. Perhaps for retinal degenerative diseases such as Stargardt’s.

      Randy

  • Joseph Vigliaturo August 26, 2014 at 2:10 pm

    we have communicated before about the scleral buckle attract me that I had 2 years ago I’ve been reading your article about the Avastin and wanted to let you know my doctor did that one about 2 months ago I have two doctors one is the retina specialist he’s the one that did the Avastin and the other isthe doctors that has done the re fractions and the lens replacement
    they also discovered that in my right eye it was the cataract that was making things much darker in the left eye which had the scleral buckle vatrectomy
    the minute that they rolled me out of the procedure Ruby after doing lens replacement in the right eye he was like a miracle I could see fingers that I haven’t seen in 2 years. I went back to the doctor that did the lens and here I checked my eyes gave me a new prescription for glasses. Still see like a shadow double, he said he put prisms in a different place on the new prescription in each eye and that should take care of it. The doctor that did the injection will have me come back soon to see if it needs to be done again.,,, just wanted to say I knowI am thankful for all the hard work that you and all these doctors are doing. Haven’t had the glasses made yet any input from you would be most welcome thanks again joe v

    • Randall V. Wong, M.D. September 2, 2014 at 9:22 am

      Joseph,

      Sounds like you are doing quite well. I can’t really make any suggestions as I can not examine you, but I’d recommend you try the glasses and go from there.

      r

  • basava October 17, 2014 at 11:46 pm

    Respected sir,

    i completed the scleral buckling right eye opration in india state karnataka in hubli city joshi hospital but my right eye vision not yet cleared.

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