Diabetic Macular Edema: Treatment, Recovery, and Where Integrative Care Fits

In short. Diabetic macular edema (DME) is swelling of the macula, the part of the retina used for reading and faces, caused by leaking blood vessels in diabetes. It is one of the more treatable causes of vision loss in diabetes. With anti-VEGF eye injections the swelling often settles and many people gain back lines on the eye chart, especially when treatment starts before vision has dropped far. Good control of blood sugar, blood pressure and cholesterol lowers the chance of it getting worse. Integrative care can sit alongside this plan. It does not replace injections.

What DME is. About 746,000 Americans aged 40 and over have DME, 3.8% of people with diabetes in that age group [1], and an estimated 21 million people worldwide [2]. It can happen at any stage of diabetic retinopathy. Early on it may cause no symptoms, which is why a yearly dilated eye exam matters even when vision seems fine. When symptoms come, they are usually blurred or wavy central vision and colours that look washed out. An OCT scan, a quick light-based picture of the retina, confirms it and shows whether the swelling involves the centre of the macula (centre-involved DME), which guides treatment.

Treatments with good evidence

Anti-VEGF injections. Aflibercept, ranibizumab, bevacizumab and faricimab block a signal (VEGF) that makes retinal vessels leak. In the DRCR Network's Protocol T trial of 660 people, eyes that started at 20/50 or worse gained on average about 19 letters with aflibercept, 14 with ranibizumab and 12 with bevacizumab after one year [3]. Most people need monthly injections at first, about 9 or 10 in the first year in that trial, then fewer as the macula stays dry.

Careful watching, when vision is still good. In Protocol V, 702 people had centre-involved DME but 20/25 vision or better. After two years, the share who lost 5 or more letters was similar whether they started with aflibercept (16%), laser (17%) or close observation (19%) [4]. About a third of the observed eyes went on to need injections. Watching is only safe with regular OCT scans and a plan to treat if vision drops.

Steroid implants. Dexamethasone and fluocinolone implants are usually used when injections do not dry the macula enough. They raise the risk of higher eye pressure and cataract, so they need monitoring.

Laser. Focal laser can treat swelling away from the centre of the macula. Scatter laser (PRP) treats proliferative retinopathy, which often travels with DME.

Blood sugar, blood pressure and cholesterol. Large trials in type 1 diabetes (DCCT) and type 2 diabetes (UKPDS) showed that better long-term blood sugar control lowers the risk of retinopathy and its progression [5], and UKPDS showed the same for tighter blood pressure control [6]. One caution: very fast drops in HbA1c can temporarily worsen retinopathy. In the SUSTAIN-6 trial of semaglutide, retinopathy complications occurred in 3.0% versus 1.8% on placebo, mostly in people who already had retinopathy [7]. Do not stop a diabetes medicine because of this; ask your physician and eye doctor to coordinate.

Treatments with some evidence

Fenofibrate. This cholesterol medicine was tested in the LENS trial of 1,151 adults in Scotland with early retinopathy or maculopathy. Over a median of four years, 22.7% on fenofibrate reached referable disease or needed treatment, versus 29.2% on placebo, and new macular edema was also reduced [8]. It did not change visual acuity over that time. It is a prescription medicine and is not suitable for everyone, especially with kidney disease, so ask your physician.

What is not proven

• Acupuncture and herbal medicine. We have not found good-quality trials showing that acupuncture, Chinese herbs or Ayurvedic herbs reduce DME swelling or improve vision. Small trials in diabetic retinopathy exist, mostly in China, and most have design weaknesses.
• Supplements sold for diabetic eyes. None has been shown to treat DME. Calcium dobesilate, a vessel-protecting drug sold in some countries, did not prevent clinically significant macular edema in a randomised trial [9].
• Anything that asks you to delay or stop injections. Long-standing swelling can damage the macula for good, so delay has a real cost.

Where Netra fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. Nothing we offer replaces your retina specialist or diabetes team, and DME care stays with them. Our role is adjunctive:

• We check that the basics are in place with your physician: HbA1c, blood pressure, cholesterol, kidney function, and your injection and scan schedule.
• We offer acupuncture and, where appropriate, Chinese herbal medicine within Netra Restoration Therapy (NRT), with the evidence explained before you start. Herbs are reviewed against your diabetes medicines, because some herbs lower blood sugar and can add to the risk of hypoglycaemia, and against kidney function.
• We take extra care with needling in people with diabetes, including skin checks and avoiding areas with poor sensation or circulation.
• We share what we see with your eye doctor and refer back quickly if your vision changes.

NRT is not a treatment for diabetic macular edema and does not replace anti-VEGF injections, laser or steroid implants. If you want to talk through whether integrative care makes sense alongside your treatment, request a consultation.

For clinic staff: ICD-10-CM codes

DME is coded within the diabetic retinopathy codes. For type 2 diabetes the pattern is E11.3[stage][edema][eye]: stage 2 mild, 3 moderate, 4 severe nonproliferative, 5 proliferative; 1 with macular edema, 9 without; eye 1 right, 2 left, 3 both, 9 unspecified. So E11.3512 is type 2 diabetes with proliferative retinopathy and macular edema in the left eye, and E11.3591 is proliferative retinopathy without macular edema in the right eye. Type 1 diabetes uses E10 with the same structure. Confirm against the current code set before billing.

Questions people ask

Can diabetic macular edema be reversed?

Often, yes. With injections the swelling frequently clears and vision improves, more so when treatment starts early. Swelling that has been present a long time can leave permanent damage, and DME can come back, so follow-up continues.

Does DME go away on its own?

Sometimes mild DME with good vision stays stable, which is why observation is an option in some cases. It needs regular scans because a third of watched eyes in Protocol V later needed injections.

How many injections will I need?

It varies. In trials most people had about 9 or 10 in the first year and fewer after that.

Is acupuncture safe if I have diabetes?

In trained hands serious harm is rare. We use sterile single-use needles, check the skin, and avoid areas of poor sensation or circulation.

References

1. Varma R, Bressler NM, Doan QV, et al. Prevalence of and risk factors for diabetic macular edema in the United States. JAMA Ophthalmol. 2014;132(11):1334-1340.
2. Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-564.
3. Diabetic Retinopathy Clinical Research Network; Wells JA, Glassman AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193-1203. PubMed.
4. Baker CW, Glassman AR, Beaulieu WT, et al. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity. JAMA. 2019;321(19):1880-1894. Summary: Retina Specialist.
5. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.
6. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317(7160):703-713.
7. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834-1844.
8. Preiss D, Logue J, Sammons E, et al. Fenofibrate and progression of retinopathy in adults with diabetes: the randomised placebo-controlled LENS trial. Health Technol Assess. 2026;30(41):1-70. First reported in NEJM Evidence, 2024.
9. Haritoglou C, Gerss J, Sauerland C, Kampik A, Ulbig MW; CALDIRET study group. Effect of calcium dobesilate on occurrence of diabetic macular oedema (CALDIRET study): randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2009;373(9672):1364-1371.