There are new treatments for the treatment of diabetic macular edema. The standard treatment using retinal laser treatment may become obsolete in the near future. New standards and technology utilizing intraocular injections and sustained release drug delivery will replace the old standard.
What is Diabetic Macular Edema?
Diabetic macular edema is the most common "complication" of diabetic retinopathy. Since almost all patients with diabetes ever obtain some degree of diabetic retinopathy in their lifetime, this is the most common manifestation of the disease.
Diabetic macular edema occurs when the normal retinal blood vessels become leaky. The fluid component of blood leaks out of the retinal blood vessels into the surrounding tissue. If the leakage occurs in the macula, the condition is called macular edema, or, diabetic macular edema.
Symptoms of "DME"
Symptoms of "DME" include slight blurring of the vision to significant vision loss, but never complete blindness. Patients can become legally blind from diabetic macular edema. It is fair to say that with more fluid accumulation, the worse the vision.
Treatment of Macular Edema
Traditionally, laser treatment for diabetic macular edema was performed in an attempt to reduce the amount of fluid accumulation, or, at least, prevent further swelling. Having said that, not all patients were great candidates for laser treatment, some responding better than others.
Maintaining status quo, that is, preventing further vision loss has always been "success."
Over the past few years, intraocular injections of steroids have proven to be very successful in achieving this condition. In fact, many patients that did not initially improve with laser treatment were able to benefit from these injections.
A small amount of steroid is injected into the eye, just to the side of the cornea. The shots are painless and well tolerated. The injected steroid may last for several weeks, yet the effects may last for months or longer.
More recently, sustained release drug delivery systems have started to emerge for the treatment of various retinal conditions. Ozurdex (Allergan) was first FDA approved for the treatment of retinal vein occlusions in the summer of 2009.
While Ozurdex also releases a steroid, it is not indicated for the treatment of diabetic retinopathy. (While it would not be wrong for a doctor to use this for treating a diabetic patient, it does mean that it would not be covered by insurance.)
In the next few months, it is anticipated that a new sustained delivery device, Iluvien (pSivida / Alimera Sciences), will be FDA approved, but this time, for the treatment of diabetic macular edema!
This will be the first drug approved specifically for diabetic macular edema and also utilizing the latest in technology for this novel application.
What Does This Mean? It is very exciting to introduce newer, and better, methods to treat disease. As a retina specialist, it will be very exciting to have another treatment in our arsenal for diabetic retinopathy .
The era of sustained release medicines for the eye is just starting. More specifically, this means that very low doses of medication, steroids, will be released for months inside the eye. The medicine has been delivered to its target and will release drug for months at a time or longer.
The early data for Iluvien is quite impressive. The drug may be FDA approved later this year. The manufacturers of Ozurdex are experiencing that it, too, will have an application for diabetic retinopathy.
The advent of sustained release delivery promises to aid us in saving vision from a very common problem … diabetes.