Diabetic macular edema: 4 answers about anti-VEGF therapy

Diabetic macular edema (DME) is one of several eye conditions that can occur when a person has diabetes.

DME is caused by fluid leaking out of blood vessels inside the eye. These fluids and substances accumulate inside the macula, a cluster of light-sensitive cells located in the back of the eyeball. The buildup causes the macula to swell.

When the macula becomes swollen, vision problems occur. Vision can become blurred or wavy, floaters can appear, and colors can seem dulled. DME can lead to blindness, especially when left untreated.

One of the mainstays of treatment for DME is injections of anti-VEGF drugs.

What is anti-VEGF?

VEGF stands for vascular endothelial growth factor. This is a signaling protein that is made and released in the body. It helps stimulate the growth of new blood vessels. 

DME typically occurs alongside another form of diabetic eye disease called diabetic retinopathy. They happen when diabetes damages the blood vessels inside the retina, causing them to leak and to become blocked. 

The body tries to compensate by creating new blood vessels, and releases VEGF inside the eye. However, high amounts of VEGF contribute to the weakening and breakdown of blood vessels in the retina, causing them to leak. In advanced stages of diabetic eye disease, new blood vessels will form, a process called neovascularization. These new blood vessels will not work well and will also leak fluid into the eye. 

Diabetic macular edema can happen at any stage of this process. Blocking VEGF helps stop blood vessels from leaking fluid into the eye. This allows the body to clear out the excess fluid in the macula and the swelling to ease.

Will anti-VEGF improve my vision?

When it comes to DME and other forms of diabetic eye disease, every person is different. A primary treatment goal is preventing DME from getting worse. Left untreated, DME will progress and eventually cause serious vision impairment or blindness.

Anti-VEGF drugs will help prevent these outcomes. Many people with DME who receive anti-VEGF therapy also see improvement in their vision. Your healthcare providers will be better able to explain what results you can expect.

What do I need to know about anti-VEGF injections?

Anti-VEGF therapy needs to be delivered directly into the eyeball with an injection, which can be intimidating. Here’s what you need to know:

• The needle used for anti-VEGF injections is very, very thin.
• A numbing agent is applied to the eye is numbed before the injection to help minimize any discomfort.
• The injection is typically painless. Most people describe feeling pressure against the eyeball, but not pain.
• The eye is washed before and after the injection.
• The procedure is done in your ophthalmologist’s office. The injection takes just a few seconds, though the appointment will be about 15 minutes.

There are several different anti-VEGF drugs available. They work differently to block VEGF in the eye and require different dosing schedules. Your ophthalmologist will advise you on your drug options and your treatment schedule.

How do I get the most out of treatment?

Anti-VEGF therapy isn’t the only treatment option for DME. Corticosteroids can also be used to reduce inflammation, and a type of laser surgery called photocoagulation can be used to close off leaking blood vessels.

Regardless of what treatment options you and your healthcare provider decide on, good diabetes management will help you get the best possible result from treatment. Controlling blood glucose levels, blood pressure, and cholesterol helps prevent further damage to the eyes, and will be an essential part of every treatment plan for DME and other forms of diabetic eye disease.