What Is Diabetic Macular Edema?

Diabetic Macular Edema (DME) is a serious eye condition and is a complication of diabetes. High blood sugar levels can result in tiny blood vessels in the back of the eye to build up with fluid and become swollen and irritated. These bulges may start to leak fluid into the eye, resulting in vision issues, and even blindness. DME usually affects both eyes. People with type 1 or type 2 diabetes can suffer from DME. The less maintained blood sugar levels are, and the longer a person has diabetes, the more likely it is to develop DME. Early detection can make the condition more treatable.

What Are the Symptoms of Diabetic Macular Edema?

Sometimes there are little to no symptoms with DME, particularly in the early stages of the condition. As the condition worsens over time, symptoms become more present. Symptoms of diabetic macular edema can include:

• Blurry vision, or double vision
• Floaters or black spots in vision
• Issues with colors appearing washed out
• Fluctuating vision
• Empty or dark areas in your vision
• Blindness

It is important to contact your eye care provider if you are experiencing any of these symptoms. Specifically, if you are diabetic, it is important to schedule regular vision appointments to maintain good eye health.

Diagnosis of Diabetic Macular Edema?

It is recommended to schedule an eye exam if having any vision problems. Additionally, it is very important for people with diabetes to schedule regular (yearly) eye exams. Typically, a doctor will perform a normal eye exam and if DME is suspected, further testing may be recommended. Some of the tests may include:

• Visual acuity test: This test uses a series of charts to assess eye health in relation to the ability to see clearly at different distances.
• Dilated eye exam: An eye doctor will administer drops to dilate the pupils in order to let more light into the eye, making it easier to assess any potential issue. The test allows a doctor to see into the back of the eye (the retina) to assess for swelling and leaking of the blood vessels, or bleeding in the macula.
• Retinol imaging: This test takes a picture of the back of the eye (the retina) and uploads it to a computer, where a doctor can assess for any issues or symptoms of DME.

If DME is suspected, additional tests may include:

• Fluorescein angiography: In this procedure, a special dye is injected into the patient’s arm and it travels up to the eye and illuminates the blood vessels. This allows the blood vessels to be visible in a digital image, and for any issue to be diagnosed.
• Optical coherence tomography: Similar to ultrasound, but instead of soundwaves, this test uses light waves to create a detailed image of the tissues inside the eye.

If any symptoms of DME are being experienced, please contact your eye doctor and schedule an exam, as early detection is helpful in treatment and prevention.

Causes and Risks of Diabetic Macular Edema

Two main causes and risks for developing DME are having consistently elevated blood sugar levels or having diabetic retinopathy. Over time, high blood sugar levels can cause damage to the blood vessels. It is important to stay diligent in monitoring and maintaining healthy blood sugar levels to prevent DME from developing. Other factors that may trigger DME are high blood pressure, high cholesterol, and sometimes pregnancy.

For people with type 1 or type 2 diabetes, other risk factors can include:

• Poor management of blood sugar levels
• High blood pressure
• High cholesterol
• Kidney disease
• Sleep apnea
• Pregnancy

If you are experiencing symptoms of DME and have any of these risk factors, please contact your eye doctor and schedule an exam, as early detection benefits treatment and prevention.

How Is Diabetic Macular Edema Treated?

There are several forms of treatment for DME. To determine the best course of treatment, a doctor will assess any underlying issues that may be causing DME and address those, and will then focus on any damage to the eye itself.

Until recently, the preferred treatment option was a procedure using a laser to seal off leaking blood vessels. However, research has shown that this is no longer the best course of action in most cases. The following treatment options have shown through clinical trials to be the safest and most effective form of treatment:

Anti-VEGF injections:

The painless procedure uses intravitreal injections to block VEGF growth. VEGF is a substance in the eye that promotes blood vessel growth. The injection seeks to block or slow down blood vessel growth. In this procedure, medication is injected through a short needle into the vitreous gel (fluid in the center of the eye). The medication aims to block growth of weak blood vessels that can burst and leak into the eye, causing macular edema.

Anti-inflammatory treatments:

Corticosteroid treatments are the most common form of treatment for DME. The steroids help to reduce inflammation in the eye associated with DME. Typically, the treatments are administered through pills, drops, or injections into the eye. The injections give a sustained-release of corticosteroids into the eye, meaning it will slowly release the anti-inflammatory medication over time. Additionally, the FDA has approved 3 types of corticosteroid sustained-release implants that release medication into the eye over an extended amount of time. Those medications are Ozurdex, Retisert, and Iluvien.

Vitrectomy:

This procedure is recommended when the gel (the vitreous) that fits in between the retina and the lens begins to pull on the macula. A vitrectomy removes the gel in order to relieve the pulling from the macula. This procedure can also help to remove blood that has collected in the vitreous, or help to correct vision when other treatments for DME have been unsuccessful.