Inclusion Criteria:  Treatment-native patients with DME secondary to type I or type II diabetes mellitus Patients who require intravitreal anti-VEGF treatment Able to understand English and complete a pain assessment Suboptimal DME responders in patients who have received 3 or 6 eylea injections (non-cytokine group)  Exclusion Criteria:  Deafness or communication disorder, known Dementia, Severe COPD/Asthma (severe lung disorder), Severe OSA, Psychiatric or Anxiety conditions, involuntary movement disorders, allergy to the anesthesia, any conditions requiring intraoperative iris manipulation, any prior ocular surgery; all patients who may need translation, are illiterate, or unable to provide consent. Pre-existing ocular pathology confounding outcome (i.e. uveitis, retinal vascular disease, macular degeneration etc.) Pre-existing uncontrolled glaucoma/high IOP Patients under 18