Diabetic Macular Oedema (DMO) Treatments

What Treatments are Available for DMO?

As DMO is effectively the manifestation of Diabetes in the eye, the treatment for DMO includes optimising the following system risk factors:

• Improve the control of Diabetes.
• Improve the control of Blood Pressure.
• Improve the control of ‘lipid profile’.

In addition to these systemic measures, the following ‘eye-specific’ treatments can be used to treat DMO:

• Laser treatment. This is the conventional treatment for DMO, useful for treating DMO that is not directly involving the central vision. However, when DMO is very close to, or involves the very centre of the macula, laser treatment can have the undesired effect of producing scarring in the central vision.
• Pharmacological treatment by Intravitreal Therapy. This is when medication is injected into the main eye cavity, the vitreous, to treat DMO. This is the modern treatment that is preferable in most cases of DMO, especially when DMO is very close to or involves the central vision.

There are two main classes of medication which are effective in the treatment of DMO. These are:

• 1. Anti-VEGF therapy
  2. Steroid therapy

What is Anti-VEGF Therapy?

The leaking capillaries in DMO, once established, are dependent on signalling molecules, the Vascular Endothelial Growth Factor (VEGF), to keep leaking.

Anti-VEGF agents are engineered humanized antibodies against VEGF. They work by blocking all the effects of VEGF on the leaking capillaries in DMO, therefore ‘drying up’ the macula in DMO.

Anti-VEGF agents are given by Intravitreal Therapy (IVT) of repeated injections into the vitreous cavity, the main eye cavity at the back of the eye.

What Anti-VEGF agents are available?

There are currently four Anti-VEGF agents which are effective and routinely used in the treatment for DMO.

• Bevacizumab (Avastin)
• Ranibizumab (Lucentis)
• Aflibercept (Eylea)
• Faricimab (Vabysmo)

What is Steroid Therapy?

Steroid Therapy, in the form of Ozurdex slow-release steroid implants, are the alternative form of Intravitreal Therapy to Anti-VEGF which is also effective in the treatment of DMO. This is especially the case if the DMO is very severe and chronic (has been present for a long time).

How do I choose between the different treatment options?

The choice of DMO treatment depends on the nature of your condition, and other funding/economic considerations. Your surgeon will discuss the choice of Anti-VEGF agents with you in detail.

What are the aims of treatment?

Intravitreal Therapy (IVT) with Anti-VEGF agents or Steroid (Ozurdex) is able to stop further deterioration of the central vision in the majority of patients (90%) with DMO. Furthermore, a small proportion of patients (20-30%) can experience major improvements in their vision.

However, the main aim of the treatment is to stop the decline in vision. It can be difficult to accurately predict whose vision will improve with the treatment on an individual patient basis, but the vision is very likely to stabilise in the vast majority of patients.

To maintain the effects of treatment, you will likely need to receive regular check-up visits, with repeated IVT treatment of either Anti-VEGF agents or Steroid (Ozurdex) from your surgeon.