Macular Edema

Although the word “retina” is used a lot, the macula and the diseases that affect it are not always known. The cells that line the inside of the eye and are sensitive to light are called the retina.

Light that hits the retina is turned into a very detailed message that is sent to the visual center of the brain by the many layers of the retina.  There the message is deciphered and then that tells us what to do.

The macula is the part of the eye that helps us see color, small details, and things that are far away. Photoreceptors are cells that respond to light. This screen has more of them than any TV or computer. It is the small, center part of the retina that is most valuable. It’s what we truly call sight. A lot of different eye problems can affect the macula, including swelling, degeneration, holes, puckering, drusen (small yellow spots), scars, fibrosis, bleeding, and vitreomacular traction. People who have macular disease often have blurred vision, twisted vision (called metamorphopsia), and blank spots (called scotoma).

Causes of Macular Edema

Pockets of fluid (usually leaky blood vessels) grow in the eye, which leads to macular edema. 

Many things can cause fluid to leak into the eye and cause macular edema, such as:

• Having diabetes. High blood sugar in people with diabetes impairs the vessels that are leaking blood into the macula.
• AMD stands for age-related macular degeneration. In AMD, blood capillaries that are tiny and fragile, break and leak fluid, which makes the macular take on fluid or swell.  This is called Macular Edema.
• Vitreomacular traction or macular pucker 
• When the vitreous doesn’t totally separate from the macula in an old eye, it pulls on the macula or forms scar tissue, and fluid builds up under it.
• RVO stands for retinal vein occlusion. When you have a blood vessel disease like RVO, the veins in your eye get jammed up. Later, blood can leak out into the macula area.
• Retinoschisis and retinitis pigmentosa are examples of genetic diseases that are passed down from parent to child.

Inflammations of the eyes.

 When the body fights its own tissues, like in uveitis, it can hurt the blood vessels in the retina and make the macula swell.

Prescription drugs. 

Eye swelling in the macula can be caused by some drugs.

Eye growths. 

Macular swelling can be caused by both good and bad growth.

Surgery on the eyes.

Macular edema doesn’t happen very often, but it can happen after surgery for glaucoma, cataracts, or the retina.

Trauma or Injuries

Treatment for cystoid macular edema

What does Cystoid Macular Edema (CME) mean?

Cystoid macular edema, or CME, is a condition that affects the central retina, or macula, but doesn’t hurt. If you have this disease, you may see multiple cyst-like spots of fluid in the macula. These cause the retina to swell, which is also called edema.

Because CME can be caused by many things, the best way to treat it will depend on the case. Your doctor may try more than one type of treatment once the diagnosis has been made and confirmed. Anti-inflammatory drugs, like corticosteroids, are generally used to treat retinal inflammation. Most of the time, these are put in the eyes as drops, but sometimes they need to be injected or taken by mouth. Physicians who specialize in eye care may also fill the eye with vascular endothelial growth factor (VEGF)-inhibitory drugs or use a laser to remove the macular edema. As well, some diuretics, like acetazolamide (Diamox), may help to lower the swelling.

The gel that fills most of the back of the eye is called vitreous. It can pull on the macula, which can lead to CME. In those cases, you might need a vitrectomy, which is surgery to remove the vitreous gel.

Treatment for diabetic macular edema

When you have diabetes, your eyes and other small blood vessels in your body get damaged by having high blood sugar for a long time.

Blood vessels can leak blood and other fluids once they are affected by diabetes. The retina is a part of your eye that can soak up extra fluid. The macula is a spot in the middle of the retina that helps you see clearly and exactly. When there is too much fluid, it can swell and get thicker.

If DME hasn’t changed the way you see yet, you might not need treatment right away.

But your eye doctor will probably want to keep a close eye out for any signs that the condition is getting worse, so you may need to go in for regular check-ups.

To keep lasting damage from happening, treatment usually starts when your vision gets worse.

Anti-VEGF Meds

Drugs that block vascular endothelial growth factor (VEGF) and drugs that are made of two types of monoclonal antibodies

These medicines stop the growth of new blood vessels and stop the leaking of blood from eye vessels that aren’t working right. Doctors of ophthalmology usually retinal specialists, give them to people by injecting them into the eye. Even though there will be some pressure during the shot, the eye is numbed first to make it as painless as possible. Several shots over time are needed for this treatment. How often they are given depends on the drug chosen and the eye doctor’s opinion.

Treatment with a focused laser for macular edema

Blood veins that leak are sealed off with laser light. Most of the time, this type of laser therapy doesn’t hurt. The treatment could leave blind spots in a person’s eyes that won’t go away. But it also helps stop or slow the growth of new blood vessels that could hurt your eyes even more. It helps protect the sight that’s still there and might even make it a little better.

Steroids for inflammation

To treat this condition, steroids are injected into the eye or an injectable steroid eye device is used. The drug is released over time to lower DME and improve eyesight.

The best treatment for macular edema caused by retinal vein occlusion

When the veins that take blood away from the eye get blocked, this is called retinal vein occlusion. This can cause the area to swell and leak fluid.  If you don’t treat it, the disease can make it hard to see, and finally, blindness may occur.

The retina swells and blood vessels leak because of vascular endothelial growth factor (VEGF), which is released when blood flow is interrupted. The Study of Comparative Treatments for REtinal Vein Occlusion 2 (SCORE2) looked at 362 people who were taking aflibercept (Eylea) and bevacizumab (Avastin), two anti-VEGF drugs. These aren’t brand-new ways to treat diabetic macular edema, but they have been shown to work. People with macular swelling that results from central retinal vein occlusion (affects the whole retina) or hemi-retinal vein occlusion (affects about half the retina) got shots once a month for six months. The study found that both methods worked just as well.

The researchers discovered that after a year, most doctors cut down on the number of anti-VEGF shots their patients got, and some moved their patients to the other anti-VEGF drug. When compared to the 12-month mark, many of the people who took part had lost some of their eye sharpness at five years. However, they were still much better than they were at the start of the study.

The two methods were not very different from one another. During the follow-up time, more injections were given to the group that was initially assigned to bevacizumab.

How to treat macular pucker and vitreomacular traction macular edema?

The most direct way to fix a macular pucker is to have a vitrectomy surgery. Patients will see a big change in their vision, but it doesn’t usually go back to normal. The vitreous is taken out during this low-impact surgery, which gets rid of vitreomacular traction. There are no stitches needed. Then, tiny tools are used to remove any extra retinal tissue that is on top of the macula.

Injections into the eye are used to treat secondary macular swelling that comes with macular pucker. These can be used on their own or with vitrectomy surgery. Along with minimally invasive vitrectomy surgery, giving patients shots to reduce swelling usually helps them see again within a few weeks of surgery.

How to Treat Macular Edema Caused by Age-Related Macular Degeneration?

Injections of anti-VEGF

When you have macular swelling, the VEGF protein in your body quickly makes new blood vessels. This causes blood vessels to grow in a way that isn’t normal, and they are more likely to break and leak blood and fluid.

Anti-VEGF shots have changed the way macula edema is treated because they can often make vision much better right after the injection.

Anti-VEGF shots help stop the VEGF proteins from making these abnormal blood vessels, which lowers the amount of fluid that leaks out and the size of the swelling.

There are three types of drugs that block VEGF:

These thin-needle shots are usually given once a month for the first six months. They are Aflibercept (Eylea), Bevacizumab (Avastin), and Ranibizumab (Lucentis). Then, over the next few years, your doctor will slowly cut back on the number of shots you get. This is called “weaning off” the drug.

New Treatments for Macular Edema

To treat wet age-related macular degeneration, diabetic macular edema, and diabetic retinopathy, the FDA has cleared a new, higher amount of Eylea®. The medicine is called Eylea HD (aflibercept) Injection 8 mg. Because the dose is bigger, people who are taking the drug may not need to get injections as often to treat these diseases. You can still get the usual Eylea 2 mg treatment. 

The usual way to treat Eylea 2 mg is to put it into the eye, first once a month and then every two months. With the new Eylea HD version, people with wet age-related macular degeneration may only need to get a shot every four months instead of every six.  

For all indications, Eylea HD should be taken once a month for the first three months. After that, people with wet AMD and diabetic macular edema should take 8 mg every two to four months, and people with diabetic retinopathy should take 8 mg every two to three months. 

The FDA approved the high-dose protocol based on the results of two clinical studies with more than 1,600 patients each. These trials were called PULSAR and PHOTON. The tests compared the 8 mg dose to the 2 mg dose and found that both were safe and effective in the same way. In the studies, the patients who got the bigger dose less often still saw improvements in their vision. 

New Eye Drops for Treating Diabetic Macular Edema

A global drug company called Oculis which focuses on eye care has revealed that the first step of its phase 3 DIAMOND study for eye drops (called OCS-01) that treat diabetic macular edema (DME) went well. 

Use of genes to treat wet AMD

Getting regular shots of drugs like Eyelea, Lucentis, and Avastin into your eyes is not ideal. Gene therapy could be a good option. Gene therapy helps the eye make its own anti-VEGF medicine so that the treatment only needs to be done once. Two different approaches are being looked into: one involves surgery to inject the gene therapy below the retina, and the other involves injecting it into the eye like any other anti-VEGF treatment, which is done in an eye doctor’s office.

Different drug options are being looked at for both wet and dry AMD. Gene therapy has a lot of potential, but we still don’t know how well it will work in the long run. This kind of treatment could be very pricey, and it might not work for all people with the problem.

Vabysmo

A new drug has been cleared by the Food and Drug Administration (FDA) to treat two diseases that lead to vision loss.

Wet age-related macular degeneration (AMD) and diabetic macular edema (DME) are two of the main reasons people lose their sight. The drug Vabysmo (faricimab-svoa) treats them.

It’s the first injectable eye medicine that has been approved to treat both diseases, and it can be given in a wider range of doses than other medicines on the market.

FAQ’s – Treatment For Macular Edema

What is the big step forward in 2023 for macular degeneration?

Syfovre – Treatment for Dry Macular Degeneration in Sarasota…

A new drug called Syfovre was cleared by the FDA in 2023 as the first way to treat dry age-related macular degeneration (AMD). Syfovre stops the complement pathway from working. Complement is part of the body’s immune system and facilitates macular degeneration to get worse.

What makes retinal edema worse?

Conditions that are likely to cause macular edema to get worse are: Higher blood pressure and diabetes make more fluid leak out of blood vessels. Make the eye more inflamed (surgery, inflammatory diseases)

If you have retinal edema, what should you stay away from?

• Foods that have been processed and contain trans fats.
• Use safflower and corn oil, which are high in vitamin E, instead of tropical oils like palm oil.
• Avoid margarine, lard, veggie oil, or both.
• Milk and cheese with a lot of fat (eggs in moderation are good for you and your eyes).
• Big cuts of beef, pork, and lamb.