How to Prevent and Treat Diabetic Macular Edema

By TCOYD on November 25, 2024   /   Diabetes Complications, Eye Health   /   Leave a comment

  Highlights:

• Diabetic retinopathy occurs when prolonged high blood sugar levels damage the blood vessels in the retina. Diabetic macular edema develops as a result of damage to the small blood vessels in the retina, caused by prolonged high blood sugar.
• You can reduce your risk of diabetic eye disease by getting annual eye exams, managing your blood sugar, controlling your blood pressure, lowering your cholesterol, wearing eye protection, and not smoking.
• Screening is essential for the early detection and prevention of vision loss since many eye conditions may not have symptoms in their early stages.
• Treatment for diabetic eye disease depends on the stage and severity of the condition. The most common treatments for diabetic macular edema include intravitreal injection, laser therapy, and corticosteroid injections.
• Early detection and appropriate treatment are the keys to avoiding serious problems with your vision, so don’t put off going to the eye doctor for regular checkups.

You probably know diabetes can affect your vision, but do you know why? When you live with diabetes, your body either does not respond well to insulin (type 2 diabetes) or it does not produce insulin at all (type 1 diabetes). Insulin is a hormone that helps deliver glucose from the bloodstream to the cells in your body. If you have too much sugar in your bloodstream for too long, over time (we’re talking years) high blood sugar can damage the tiny blood vessels in the eyes, leading to conditions like diabetic retinopathy, macular edema, glaucoma, and cataracts. These complications can threaten your vision if left unmanaged. But with regular checkups, good blood sugar control, and a few other tips we’ll discuss in this article, you can prevent or delay the complications that lead to diabetic eye disease.

Understanding How Diabetic Retinopathy Can Lead to Diabetic Macular Edema

Diabetic Retinopathy (DR) occurs when prolonged high blood sugar levels damage the blood vessels in the retina (the light-sensitive tissue at the back of the eye). As these vessels become weakened, they can leak fluid or blood, leading to swelling and the formation of scar tissue. In advanced stages, new abnormal blood vessels may grow, causing further complications. The condition typically progresses slowly and may not show symptoms in its early stages, which is why regular eye exams are crucial for early detection and management. Diabetic macular edema (DME) occurs when diabetic retinopathy affects the macula (MAK‐yu‐lah). The macula is a small indent on the retina that helps you see fine details.

Diabetic Macular Edema (DME) is associated with diabetic retinopathy. It develops as a result of damage to the small blood vessels in the retina, caused by prolonged high blood sugar levels. When these blood vessels become weakened, they can leak fluid into the retina, specifically in the macula (the part of the retina responsible for sharp, central vision). The fluid leakage causes swelling which interferes with the macula’s ability to function properly, making it difficult to see fine details, read, or recognize faces. It can occur at any stage of diabetic retinopathy, though it is more common in the later stages.

 

           

How to Reduce Your Risk of Diabetic Macular Edema

Here are six ways you can significantly reduce the risk of diabetic eye disease:

1. Get annual eye exams.
2. Manage blood sugar. Make every effort to control your blood sugars as best as you can. An HbA1c as close as possible to 7% and/or time in range of 70%  is ideal.
3. Control blood pressure. Get your own blood pressure cuff and learn how to use it! Your values should be below 130 over 85 mmHg most of the time. Make sure to measure at different times of the day.
4. Lower cholesterol. For people with diabetes it is recommended you keep your LDL cholesterol below 70 mg/dL, triglycerides below 200 mg/dL, and HDL as high as you can get it. But your levels are really a result of heredity….what is passed on in the genes from your parents.
5. Stop smoking. Smoking can cause further damage to your blood vessels (we know it is a tough habit to break, so get help).
6. Wear protection…for your eyes. Protect yourself from ultraviolet rays by wearing sunglasses. Exposure to these rays can speed up the progression of cataracts. And remember to protect your eyes when working around equipment, or anything else that may cause eye trauma.

 Screening Recommendations for Diabetic Macular Edema

Screening is essential for the early detection and prevention of vision loss, especially since many eye conditions such as diabetic retinopathy and diabetic macular edema may not show symptoms in their early stages. Every year you should have a comprehensive dilated eye exam performed by an eye specialist who is very familiar with diabetic eye problems. This would be an ophthalmologist with a special interest in diabetic eye disease or a retina specialist if you already have documented problems. Your retina specialist may order other tests such as retinal photography, OCT test, fluorescein angiography, visual acuity test, tonometry, etc.

Treatments for Diabetic Macular Edema

Treatment for diabetic eye disease depends on the stage and severity of the condition. Early-stage retinopathy may not require immediate intervention beyond better diabetes management, but more advanced stages require medical treatment to prevent vision loss.

The most common treatments for diabetic  macular edema include:

1. Intravitreal injection (IVT)

An IVT is a procedure that involves injecting medication directly into the eye. These injections help decrease swelling in the retina which can lead to eye damage in people with diabetic macular edema. In diabetic macular edema, two types of proteins—VEGF and Ang-2—can cause abnormal blood vessels to grow, swell, and leak fluid, which can lead to potential vision loss. Some IVTs only target VEGF, but VABYSMO^Ⓡ (faricimab-svoa) works differently.

VABYSMO is a prescription medicine given by injection into the eye used to treat adults with diabetic macular edema. It is the only FDA-approved treatment thought to block* 2 causes of DME (VEGF and ANG-2).  VABYSMO improves vision quickly,^† while delivering a chance for up to 4 months between treatments.^‡

*The benefit of blocking Ang-2 has yet to be established.

^†Clinical studies showed people on VABYSMO gained vision on an eye chart (11 letters on average), similar to those on aflibercept 2 mg through year 1.

^‡After 4 or 6 initial monthly eye injections, your doctor will choose a schedule of 1 to 4 months based on patient response. Dosing may vary.

VABYSMO could cause eye infection and retinal detachment, see the end of the article for more information about possible side effects.

2. Laser Therapy (Photocoagulation)

Laser photocoagulation is a common treatment for diabetic retinopathy. It involves focusing a laser on the retina to seal leaking blood vessels or shrink abnormal ones. The procedure helps prevent further blood vessel growth, leakage, and progression of the disease. Focal laser therapy targets specific areas of leakage, while pan-retinal photocoagulation treats a broader area of the retina.

3. Corticosteroid Injections

Steroids, delivered either through injections or implants, help reduce inflammation and swelling in the retina, particularly in diabetic macular edema. Corticosteroid treatments are often long-acting, requiring fewer injections. While effective, they can have side effects like increased eye pressure or cataract formation, so their use must be carefully monitored.

A combination of treatments is sometimes necessary for optimal results, depending on the severity and individual response. Regular follow-ups with an ophthalmologist are essential to monitor the condition and adjust treatment as needed.

Advocating for Yourself and Your Vision

If you already have some form of diabetic eye disease, don’t be hard on yourself. Be proactive, stay educated about your condition, see a retina specialist if needed, and ask your doctor about the best treatment options for you. If insurance or finances are an issue, ask your doctor and/or the medication manufacturer about patient support programs that may be able to help you afford your medicine.

The Bottom Line

Early detection and appropriate treatment are the keys to avoiding serious problems with your vision, so don’t put off going to the eye doctor. Mark it on your calendar to get a dilated eye exam at least once a year – preferably by someone familiar with diabetic eye disease – even if you don’t have symptoms.

You are the most important member of your healthcare team and your own best ally. The things you are (hopefully!) already doing to manage your diabetes – like keeping your blood sugar, blood pressure, and cholesterol in healthy ranges as much as possible – can go a long way in preventing eye complications.

 

Created in partnership with Genentech, a sponsor of TCOYD at the time of publication.

What is VABYSMO?

VABYSMO (faricimab-svoa) is a prescription medicine given by injection into the eye used to treat adults with neovascular (wet) age‑related macular degeneration (AMD) and diabetic macular edema (DME),

Do not receive VABYSMO if you:

• Have an infection in or around your eye.
• Have active swelling around your eye that may include pain and redness.
• Are allergic to VABYSMO or any of the ingredients in VABYSMO.

What is the most important information I should know about VABYSMO?

• Injections like the one for VABYSMO can cause an eye infection (endophthalmitis) or separation of layers of the retina (retinal detachment). Call your healthcare provider right away if you have increasing eye pain, vision loss, sensitivity to light, or redness in the white of the eye.
• VABYSMO may cause a temporary increase in pressure in the eye (intraocular pressure), which occurs within 60 minutes after receiving the eye injection.
• Although not common, VABYSMO patients have had serious, sometimes fatal, problems related to blood clots, such as heart attacks or strokes (thromboembolic events). In clinical studies for wet AMD during the first year, 7 out of 664 patients treated with VABYSMO reported such an event. In clinical studies for DME from baseline to week 100, 64 out of 1,262 patients treated with VABYSMO reported such an event.
• Severe inflammation of vessels in the retina has happened for patients treated with VABYSMO. Call your healthcare provider immediately if you experience a change in vision.

Before receiving VABYSMO, tell your healthcare provider about all of your medical conditions, including if you:

• Are pregnant or plan to become pregnant. Based on how VABYSMO interacts with your body, there may be a potential risk to your unborn baby. You should use birth control before your first injection, during your treatment with VABYSMO, and for 3 months after your last dose of VABYSMO.
• Are breastfeeding or plan to breastfeed. It is not known if VABYSMO passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you receive VABYSMO.
• Are taking any medications, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Tell your healthcare provider about all the medicines you take.

What should I avoid while receiving VABYSMO?

• Your vision may be impaired after receiving an eye injection or after an eye exam. Do not drive or use machinery until your vision has recovered sufficiently.

 What are the most common side effects with VABYSMO?

• The most common side effects with VABYSMO were cataract and blood on the white of the eye (conjunctival hemorrhage).
• These are not all the possible side effects of VABYSMO.

Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555.

Please see the VABYSMO full Prescribing Information for additional Important Safety Information.