Diabetic retinal oedema, also known as diabetic macular oedema, is a serious vision-threatening complication that can develop in people living with diabetes. When high blood sugar levels damage the blood vessels in the eye, fluid can leak into the central part of the retina called the macula, causing swelling that may lead to vision problems or even blindness if left untreated.

How Treatment Can Help Preserve Your Vision

If you have been diagnosed with diabetic retinal oedema, it is important to understand that the main goal of treatment is to preserve your vision and prevent further damage to your eyes. The swelling in your retina does not repair itself without intervention, and delaying treatment can allow the condition to worsen. Early treatment offers the best chance of stabilizing your vision or, in some fortunate cases, even improving it.

Treatment approaches depend on several factors, including how severe the swelling is, how well your blood sugar and blood pressure are controlled, and how your body responds to different therapies. Some people need only a few treatments to see improvement, while others require ongoing care over many months or years. The condition affects about 1 in 14 people with diabetes, making it one of the most common causes of vision loss among those living with this disease.^[1]

There are two main ways doctors approach treatment. First, they focus on managing the underlying health conditions that contribute to the problem, such as high blood sugar and high blood pressure. Second, they use medical interventions specifically designed to reduce the swelling in your retina and stop blood vessels from leaking. Both aspects work together to protect your eyesight.

Standard Treatments for Diabetic Retinal Oedema

The most widely used treatment for diabetic retinal oedema involves medications that are injected directly into the eye. This might sound alarming, but the procedure is performed with numbing drops so you should not feel pain during the injection. These medications belong to a class called anti-VEGF drugs, which stands for anti-vascular endothelial growth factor. VEGF is a protein in your body that promotes the growth of new blood vessels. When you have diabetic retinal oedema, your body produces too much VEGF, causing weak and leaky blood vessels to form in your retina.^[1]

Anti-VEGF medications work by blocking this protein, which helps stabilize existing blood vessels and prevents new, fragile vessels from growing. The most commonly used anti-VEGF drugs include aflibercept (marketed as Eylea), bevacizumab (Avastin), brolucizumab-dbll (Beovu), and ranibizumab (Lucentis). A newer medication called faricimab-svoa (Vabysmo) blocks both VEGF and another protein called angiopoietin-2, which also plays a role in blood vessel formation. This dual action may provide longer-lasting effects, meaning you might need fewer injections over time.^[12]

Most people need one injection per month for the first four to six months of treatment. After this initial phase, the frequency of injections typically decreases, though many patients continue to need them periodically over several years to prevent the swelling from returning. Once the blood vessels stop leaking and the swelling goes down, many people notice their vision improves.^[12]

For people who have vision of 20/50 or worse, studies suggest that aflibercept may work better than bevacizumab and ranibizumab. However, not everyone responds equally well to anti-VEGF treatment. Research shows that between 31 and 65 percent of patients still have persistent swelling even after multiple injections.^[9]

When anti-VEGF injections alone do not provide enough benefit, doctors may recommend corticosteroid medications. Steroids work differently than anti-VEGF drugs; they target inflammation in the retina rather than blocking blood vessel growth. Corticosteroids can be given as injections or through a tiny implant placed in your eye. The implant slowly releases small doses of medication over time, eliminating the need for frequent injections. One example is dexamethasone, which is used for chronic cases that do not respond well to other treatments.^[12]

However, steroids are usually not the first choice for treatment because they can cause side effects such as cataracts (clouding of the eye’s lens) and glaucoma (increased pressure in the eye). For this reason, doctors typically try anti-VEGF medications first and reserve steroids for cases where other treatments have not worked adequately.^[12]

In addition to injections, some patients may benefit from laser treatment, specifically a procedure called focal-grid macular laser surgery. During this treatment, a laser is used to seal leaking blood vessels in the retina, which helps reduce swelling. Laser treatment is sometimes combined with anti-VEGF injections when injections alone are not sufficient. If you have diabetic retinal oedema in both eyes, your doctor will treat one eye at a time, waiting a few weeks before treating the second eye. Usually, only one laser session is needed for each eye.^[10]

Another type of medication sometimes used is nonsteroidal anti-inflammatory drugs (NSAIDs) in the form of eye drops. These medications fight inflammation like steroids do, but without the same side effects. Doctors may prescribe NSAID eye drops to help prevent or reduce swelling before or after eye surgery. They are less commonly used as a standalone treatment for diabetic retinal oedema but can be helpful in certain situations.^[12]

Beyond these eye-specific treatments, managing your overall health is absolutely essential. Your doctor will work with you to keep your blood sugar levels, blood pressure, and cholesterol within healthy ranges. This might involve adjusting your diabetes medications, starting blood pressure medications, or making changes to your diet and exercise habits. Controlling these factors is critical because high blood sugar is what causes the blood vessel damage in the first place. No amount of eye treatment will be fully effective if your blood sugar remains poorly controlled.^[8]

Emerging Treatments in Clinical Research

While the standard treatments described above are effective for many people, researchers are continuously working to develop new therapies that might work better, last longer, or help people who do not respond well to current options. These experimental treatments are being tested in clinical trials, which are carefully controlled research studies involving volunteer participants.

One area of active research involves developing new anti-VEGF medications that might be more powerful or longer-lasting than the ones currently available. Scientists are also investigating combination therapies that target multiple pathways involved in diabetic retinal oedema at the same time. For example, some trials are testing medications that block both VEGF and inflammatory molecules simultaneously, with the hope that this dual approach might be more effective than treating each problem separately.

The biology behind diabetic retinal oedema is complex. It is not just about leaky blood vessels; the condition also involves inflammation, damage to the neurovascular units (the partnerships between nerve cells and blood vessels in the retina), and even death of nerve cells. Researchers are exploring therapies that could protect these nerve cells from damage, which would be especially valuable because nerve cell death is irreversible and leads to permanent vision loss.^[9]

Some clinical trials are testing medications that work on different biological targets than VEGF. These include drugs that affect inflammatory pathways, proteins involved in cell stress responses, or enzymes that contribute to blood vessel leakage. By approaching the problem from different angles, researchers hope to find treatments that work for people who do not respond to anti-VEGF therapy.

Another promising area of research involves improving the delivery of medications to the eye. Currently, most treatments require repeated injections, which can be inconvenient and carry a small risk of complications with each injection. Scientists are developing longer-acting drug formulations, implantable devices that slowly release medication over many months, and even eye drops that could potentially deliver medication to the retina without needles. These advances could make treatment much easier and more comfortable for patients.

Clinical trials typically go through several phases. Phase I trials focus primarily on safety, testing a new treatment in a small group of people to see if it causes harmful side effects. Phase II trials involve more participants and aim to determine whether the treatment actually works and what dose is most effective. Phase III trials are large studies that compare the new treatment directly against the current standard treatment to see if it is better, equivalent, or not as good. Only treatments that successfully complete all these phases can be approved for widespread use.

If you are interested in participating in a clinical trial, discuss this option with your eye doctor. Participation in research can give you access to cutting-edge treatments before they become widely available, and you would be contributing to scientific knowledge that could help future patients. However, clinical trials also involve uncertainties, such as the possibility that the experimental treatment might not work or could cause unexpected side effects. Your doctor can help you understand the potential benefits and risks.

Supporting Your Vision Through Lifestyle Changes

Medical treatments are only part of the picture when it comes to managing diabetic retinal oedema. The lifestyle choices you make every day play a crucial role in slowing the progression of the condition and protecting your vision for the long term.

The single most important thing you can do is keep your blood sugar levels as close to normal as possible. High blood sugar is what damages the blood vessels in your retina in the first place. Studies have shown that improving blood sugar control can actually reduce the need for ongoing eye treatments. Some people who successfully manage their diabetes find that they need fewer injections or that the swelling in their retina stabilizes without continuous intervention.^[17]

Regular physical activity is beneficial not only for blood sugar control but also directly for your eye health. Research suggests that exercise increases blood flow to the tissues in your retina. Experts recommend at least 150 minutes of physical activity each week. This does not have to be intense exercise; moderate activities like walking, swimming, cycling, or dancing all count. Even small amounts of movement are better than none, so start with what feels manageable and gradually increase.^[18]

What you eat matters tremendously. A diet rich in fruits, vegetables, whole grains, and lean proteins helps keep your blood sugar, blood pressure, and cholesterol in healthy ranges. Many doctors recommend the “plate method” as a simple way to visualize healthy eating: fill half your plate with vegetables and fruits, one quarter with protein (such as fish, poultry, beans, or nuts), and one quarter with whole grains. Choose healthy fats like olive oil over butter, and limit your salt intake to no more than about three-quarters of a teaspoon per day. Avoid sugary drinks and processed foods when possible.^[18]

If you smoke, quitting is one of the best things you can do for your eyes and your overall health. The nicotine in tobacco products worsens diabetes complications and increases the risk of vision loss. Quitting smoking is challenging, but many resources are available to help, including nicotine replacement products (patches, gum, lozenges), prescription medications, and counseling. Talk to your healthcare provider about which approach might work best for you.^[18]

Managing stress is also important because stress hormones can cause temporary spikes in blood sugar and blood pressure. Find healthy ways to cope with stress, such as deep breathing exercises, meditation, yoga, spending time in nature, or talking with a counselor or support group. Stress can also lead to unhealthy coping behaviors like overeating, drinking too much alcohol, or neglecting your diabetes care, so addressing stress proactively benefits your health in multiple ways.^[18]

Blood pressure control deserves special attention. High blood pressure makes diabetic retinal oedema worse and accelerates vision loss. In addition to medication if prescribed, you can lower blood pressure through weight loss (even 10 pounds can make a difference), limiting alcohol to no more than one drink per day, exercising regularly, and managing stress. These measures work together to protect both your eyes and your cardiovascular system.^[18]

Living Well Despite Vision Changes

If diabetic retinal oedema has already affected your vision, know that many tools and strategies can help you maintain independence and quality of life. Vision changes can feel frightening and frustrating, but with the right support and adaptations, most people continue to do the activities they value.

Low vision aids are specialized tools designed to help people with reduced vision. Magnifying glasses come in many forms, including handheld magnifiers, stand magnifiers for reading books, clip-on magnifying lenses for your regular glasses, and electronic magnifiers that display enlarged text on a screen. Bright reading lamps or high-intensity lights can make it easier to see details. Electronic devices like e-readers, computers, and tablets allow you to adjust font sizes, and many smartphones have built-in accessibility features such as screen magnification and voice-to-text functions.^[15]

Vision rehabilitation services, provided by ophthalmologists, occupational therapists, or low vision specialists, can make a significant difference. During a vision rehabilitation assessment, a professional evaluates your remaining vision and teaches you strategies to make the most of it. This might include exercises to improve reading skills, techniques for completing household tasks safely, and recommendations for assistive devices tailored to your specific needs. Research has shown that vision rehabilitation helps people with diabetic retinal oedema regain a sense of independence and confidence.^[15]

Organizing your home and work environments can simplify navigation and daily tasks. Use large-print labels on food containers, medication bottles, and storage drawers. Organize clothing by color using safety pins or by keeping matched socks together with special clips before washing. Mark frequently used settings on appliances like stoves or washing machines with textured paint or silicone caulk that you can feel with your fingertips. Keep your living spaces tidy and free of obstacles to reduce the risk of falls.^[15]

If you are struggling emotionally with vision loss, you are not alone. It is natural to feel scared, frustrated, or sad when your vision changes. Many people find it helpful to connect with others who understand what they are going through, whether through in-person support groups, online communities, or counseling. Your eye doctor or primary care provider can refer you to resources and support services in your area.

Most Common Treatment Methods

• Anti-VEGF Injections
  • Aflibercept (Eylea) blocks vascular endothelial growth factor to prevent leaky blood vessel formation
  • Bevacizumab (Avastin) stabilizes blood vessels and reduces fluid leakage
  • Ranibizumab (Lucentis) helps prevent new abnormal blood vessels from growing
  • Brolucizumab-dbll (Beovu) provides targeted VEGF blockade
  • Faricimab-svoa (Vabysmo) blocks both VEGF and angiopoietin-2 for potentially longer-lasting effects
  • Typically given monthly for four to six months initially, then less frequently
• Corticosteroid Therapy
  • Dexamethasone injections or implants reduce inflammation and swelling in the retina
  • Triamcinolone acetonide injections decrease fluid buildup
  • Used for chronic cases that do not respond adequately to anti-VEGF treatment
  • Implants provide slow medication release over time, reducing injection frequency
• Laser Treatment
  • Focal-grid macular laser surgery seals leaking blood vessels
  • Reduces swelling by targeting specific areas of leakage
  • Often combined with anti-VEGF injections when injections alone are insufficient
  • Usually requires only one treatment session per eye
• Blood Sugar Management
  • Diabetes medications adjusted to maintain target blood sugar levels
  • Continuous glucose monitoring to track patterns throughout the day
  • Dietary modifications including the plate method for balanced nutrition
  • Regular physical activity to improve insulin sensitivity and blood sugar control
• Blood Pressure Control
  • Antihypertensive medications to maintain healthy blood pressure
  • Lifestyle modifications including salt restriction and weight loss
  • Regular monitoring to ensure blood pressure remains in target range