Macular oedema is a condition where fluid builds up in the central part of the retina, causing the macula to swell. While it can blur vision and affect everyday activities like reading and driving, treatment options exist to reduce swelling and protect sight, and ongoing research continues to explore new ways to help people preserve their vision.

Understanding Treatment Goals for Macular Oedema

When the macula swells with fluid, it creates a challenge that requires careful medical attention. The main goal of treating macular oedema is to reduce the swelling in the retina and prevent further damage to vision. For many people, treatment can stabilise vision and even lead to improvements, making it easier to carry out daily tasks that require clear central vision^[1].

Treatment approaches depend heavily on what is causing the swelling in the first place. The macula can swell for many different reasons, from diabetes-related blood vessel damage to inflammation following eye surgery. Each underlying cause may require a different treatment strategy. This is why eye doctors carefully assess each person’s situation before recommending a particular course of action^[2].

The stage and severity of macular oedema also influence treatment decisions. Some people experience only mild blurring when the swelling is minimal or doesn’t affect the very centre of the macula. Others may have more severe central vision loss that interferes with reading, recognising faces, or driving. The extent of vision changes helps doctors determine how urgent and intensive treatment needs to be^[8].

Beyond medical treatments approved by health authorities and professional societies, researchers continue to investigate new therapies through clinical trials. These studies explore innovative approaches that might offer benefits to people who don’t respond well to current treatments or who need additional options. Participating in research can sometimes provide access to cutting-edge therapies before they become widely available^[11].

Standard Treatment Approaches

The treatment of macular oedema begins with addressing the underlying condition that caused the fluid to accumulate. For people with diabetes, managing blood sugar levels is absolutely essential. High blood sugar damages the tiny blood vessels in the retina, causing them to leak fluid into the macula. Keeping blood sugar and blood pressure within target ranges can slow the progression of swelling and sometimes prevent further vision loss^[6].

One of the most widely used treatments involves injecting medication directly into the eye. This might sound uncomfortable, but these injections are typically described as painless by patients. The drugs most commonly used are called anti-VEGF medications, which stands for anti-vascular endothelial growth factor. These medicines work by blocking a protein in the body that causes abnormal blood vessels to grow and leak. By stopping this process, the medications help reduce fluid leakage and bring down swelling in the macula^[9].

The specific anti-VEGF drugs that have been approved for treating macular oedema include aflibercept (also known by the brand name Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis). Studies have shown that these medications can be equally effective in improving vision. During the first six months of treatment, injections are usually given once a month. After this initial period, doctors typically reduce the frequency of injections, spreading them out over longer intervals. The treatment schedule is adjusted based on how well the swelling responds and whether vision improves^[9][11].

For macular oedema caused by inflammation, a different type of medication may be used. Corticosteroids, commonly known as steroids, target inflammation in the body and can reduce retinal swelling. One such medication is Ozurdex, which has been licensed for treating macular oedema due to retinal vein occlusion and inflammation at the back of the eye. Steroids can be injected into the eye or implanted during a surgical procedure. When implanted, they release medicine slowly over time and eventually dissolve inside the eye^[2][10].

However, steroid treatments are generally not recommended as a first choice because they can lead to complications. Prolonged use of steroids in the eye may increase the risk of developing cataracts or glaucoma, both of which are serious eye conditions. For this reason, anti-VEGF injections are usually preferred when they are suitable for the underlying cause of swelling^[9].

Eye drops may also play a role in treating certain types of macular oedema. Non-steroidal anti-inflammatory eye drops, or NSAIDs, can help reduce inflammation without the side effects associated with steroids. These drops may be prescribed before or after eye surgery to prevent or treat swelling. In some cases, such as macular oedema associated with inherited retinal diseases like retinitis pigmentosa, doctors may prescribe eye drops containing Dorzolamide (such as Trusopt) or tablets containing Acetazolamide^[2][10].

Laser treatment is another established option, particularly a procedure called focal-grid macular laser surgery. During this treatment, the doctor uses a laser to seal leaking blood vessels in the retina. The laser creates small burns that stop the fluid from seeping out, which helps bring down the swelling. This procedure is typically performed on one eye at a time, allowing each eye a chance to heal before treating the other. The second eye is usually treated within a couple of weeks. Laser surgery is often used in combination with anti-VEGF injections if the medications alone don’t provide sufficient improvement^[9].

In more severe or persistent cases, surgery may be necessary. A procedure called vitrectomy involves removing blood vessels, blood, and scar tissue from the vitreous gel inside the eye. This surgery is typically reserved for situations where other treatments have not been successful or where there are complications such as significant scar tissue formation^[4].

The duration of treatment varies widely depending on the individual and the underlying cause. Some people need ongoing treatment for several years, while others may be able to gradually reduce the frequency of interventions as their condition stabilises. It’s important to maintain regular follow-up appointments with an eye doctor, as macular oedema can take weeks or months to heal, and continuous monitoring ensures that treatment remains effective^[6].

Side effects from injections are generally rare, but they can occur. Some people experience temporary discomfort, redness, or increased pressure in the eye after an injection. More serious complications, such as infection or retinal detachment, are uncommon but possible. Laser treatment can also have side effects, including temporary blurring or spots in vision. Your doctor will discuss these risks with you and monitor for any complications during your treatment^[1].

Treatment in Clinical Trials

Researchers around the world are actively investigating new treatments for macular oedema, and clinical trials offer opportunities to access therapies that are not yet widely available. These studies are especially important for people who don’t respond well to current standard treatments or who experience side effects that make it difficult to continue with conventional therapies^[11].

One significant area of research focuses on improving anti-VEGF treatments. Scientists are working to develop new versions of these medications that might work more effectively or last longer in the eye, potentially reducing the number of injections needed. Some trials are testing drugs that combine anti-VEGF effects with other mechanisms of action, aiming to address multiple factors that contribute to macular swelling at the same time. This could offer better outcomes for people with complex or hard-to-treat forms of oedema.

A major clinical trial called the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) has provided valuable insights into treating macular oedema caused by blocked veins in the retina. This study compared aflibercept and bevacizumab in patients with central retinal vein occlusion or hemi-retinal vein occlusion. Both medications were found to be equally effective in improving vision. Patients received monthly injections for the first six months, followed by treatment adjusted according to their individual needs. The study tracked patients for five years and found that many retained significant vision improvements compared to when they first started treatment, although some people experienced a gradual decline after the first year. These long-term results help doctors understand how to manage treatment over time and what outcomes patients can realistically expect^[11].

Clinical trials typically progress through several phases. Phase I trials focus primarily on safety, testing new drugs in a small number of people to understand how the body processes the medication and what doses are safe. Phase II trials expand to include more participants and begin to assess whether the treatment actually works to reduce macular oedema and improve vision. These studies also continue to monitor safety. Phase III trials are large studies that compare the new treatment directly with current standard therapies, providing the evidence needed for regulatory approval^[11].

Some research focuses on entirely new approaches to treating macular oedema. For example, scientists are exploring therapies that target inflammation pathways in different ways than current steroid treatments. Others are investigating whether certain genes or biological markers can predict who will respond best to specific treatments, allowing for more personalised medicine. This type of research could eventually help doctors choose the most effective treatment for each individual from the start, rather than relying on trial and error.

Gene therapy represents another frontier in macular oedema research. This experimental approach involves introducing genetic material into cells to produce therapeutic proteins continuously, potentially eliminating the need for repeated injections. While still in early stages of investigation, gene therapy holds promise for providing long-term control of blood vessel growth and leakage with a single treatment.

Clinical trials take place in various locations around the world, including in Europe, the United States, and other regions. Eligibility for trials depends on many factors, including the type and severity of macular oedema, previous treatments received, overall health status, and specific criteria set by the researchers. If you’re interested in participating in a clinical trial, speak with your eye doctor, who can help you understand what studies might be appropriate for your situation and how to find them^[11].

Most Common Treatment Methods

• Anti-VEGF injections
  • Medications like aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis) are injected into the eye to block proteins that cause abnormal blood vessel growth and leakage
  • Usually given monthly for the first six months, then less frequently based on individual response
  • These injections help reduce fluid leakage and swelling in the macula
• Corticosteroid treatments
  • Medications like Ozurdex target inflammation in the eye
  • Can be given as injections or slow-release implants that dissolve over time
  • Used particularly for macular oedema caused by retinal vein occlusion or inflammation following eye surgery
  • Steroid eye drops may also be prescribed in some cases
• Laser treatment
  • Focal-grid macular laser surgery uses targeted laser burns to seal leaking blood vessels
  • Performed on one eye at a time with healing periods between treatments
  • Often used in combination with anti-VEGF injections
• Non-steroidal anti-inflammatory medications
  • NSAID eye drops help reduce inflammation without steroid-related side effects
  • May be prescribed before or after eye surgery to prevent swelling
• Specific medications for inherited conditions
  • Dorzolamide eye drops or Acetazolamide tablets for macular oedema associated with conditions like retinitis pigmentosa
• Surgical intervention
  • Vitrectomy surgery removes blood vessels, blood, and scar tissue from the eye
  • Reserved for severe or persistent cases where other treatments haven’t worked