Diabetic Macular Edema: What to Know

Diabetic macular edema (DME) is a complication of diabetic retinopathy in which fluid builds up in the macula, or central part of the retina. It is the most common cause of vision loss in people with diabetes, and the leading cause of new blindness in the United States.

Thankfully, there are several steps you can take to help prevent diabetic macular edema. If you already have diabetic macular edema, there are several treatment options that can help relieve your symptoms.

This article will discuss the symptoms, causes, treatments, and risk factors for diabetic macular edema.

What to expect during a routine eye exam

Types of Diabetic Macular Edema

There are two main types of diabetic macular edema: non-central diabetic macular edema (mild) and central diabetic macular edema (severe).

Mild and severe diabetic macular edema

In diabetic macular edema with noncentral involvement, the retinal thickening around the macula is 1 mm or greater, but the central subregion of the macula is not involved. In centrally involved diabetic macular edema, retinal thickening of 1 mm or greater in diameter does involve a central subregion of the macula, often resulting in progressive vision loss.

Diabetic macular edema test

To find out if you have diabetic macular edema, your healthcare provider may use one or more of the following tests:

  • Vision test: This is a standard test you usually have at your annual eye exam. It consists of a chart with letters and numbers that decrease in size as you read from top to bottom. Your healthcare professional will usually ask you to cover one eye and read from the lowest line you can see clearly, then you will switch eyes.
  • Amsler Grid: Passing this test, you can wear reading glasses if you use them regularly. The grids are placed at the same distance as they would normally be placed when reading newspapers or books. You’ll cover one eye and mark any unclear parts of the grid. You’ll switch eyes and mark the chart again.
  • Mydriatic eye exam: Your healthcare provider will give you eye drops to make your pupils larger. Once they are dilated, your healthcare provider will examine the retina to see if there is a buildup of fluid around the macula.
  • Optical coherence tomography: Using a special light and camera, your healthcare professional will see if and how thick the retina is and if the macula is swollen.
  • Fluorescein angiography: To see if there is any damage (or extent of damage) to the macula, your healthcare professional will inject a dye into your arm, which travels through the blood vessels. During this process, a camera takes pictures of your retina to look for damage or disease related to diabetic macular edema.

What You Need to Know About Diabetic Retinopathy Screening

Symptoms of Diabetic Macular Edema

Vision changes are the main symptom of diabetic macular edema. These include blurred or distorted vision near or in the center of your field of vision. Colors may also appear dull or washed out.

Why Diabetics Have Blurred Vision

Causes of diabetic macular edema

Diabetic macular edema is a complication of diabetes that develops over time due to poor blood sugar control. It doesn’t happen by itself. Persistent high blood sugar can damage the small blood vessels in the eye.

Initially, the damage starts with diabetic retinopathy, which damages your vision. If left untreated, fluid from these damaged blood vessels can seep into the macula, leading to diabetic macular edema.

who has diabetic macular edema

Anyone with type 1 or type 2 diabetes can have diabetic macular edema.

Prevalence of diabetic macular edema

About 7.7 million Americans have diabetic retinopathy, according to the National Eye Institute. Of these, about 10% suffer from diabetic macular edema. Non-Hispanic African Americans are three times more likely to develop diabetic macular edema than non-Hispanic whites.

Risk factors for diabetic macular edema

Several risk factors can contribute to diabetic macular edema. These include:

  • diabetes
  • kidney disease
  • very high blood pressure
  • high levels of fat in the blood
  • fluid retention
  • pregnant

Treating diabetic macular edema

Treatment of diabetic macular edema begins with treating the diabetes itself. However, depending on the type or severity of diabetic macular edema, you may need additional treatment. These include injectable anti-vascular endothelial growth factor (anti-VEGF) drugs, laser therapy, and anti-inflammatory treatments.

Injectable anti-VEGF drugs

Anti-VEGF drugs stop the development of new blood vessels, as well as the leakage of abnormal blood vessels that can overwhelm the macula.

These medicines are injected directly into the eye, so you may experience some mild pressure. Your healthcare provider will determine how many injections you need to see results.

The American Diabetes Association recommends anti-VEGF injections as first-line treatment for most patients with central diabetic macular edema that impairs vision.

Laser Treatment

With a laser, your healthcare provider will try to close and destroy any blood vessels that seep into the macula. This procedure is usually painless and can help slow or stop the growth of new blood vessels that can further damage vision.

While laser therapy can help protect your vision and possibly even improve it, you can also develop permanent blind spots.

Anti-inflammatory drugs

Corticosteroids can be used to reduce swelling of blood vessels that cause fluid buildup in the macula. They are administered by using pills, eye drops, or injections in the eye.

To reduce the number of injections, an implant containing an extended-release corticosteroid may be an option in the eye. If your eyes don’t respond to steroids or you experience side effects from steroids, your healthcare provider may try nonsteroidal anti-inflammatory drugs (NSAIDs).

According to the American Diabetes Association, people with persistent diabetic macular edema despite anti-VEGF therapy (or those who are not suitable for this treatment) may benefit from laser therapy or injections of corticosteroids into the eye.

Prevent diabetic macular edema

The best preventive measures for diabetic macular edema are managing your diabetes and following a healthy lifestyle. Maintaining proper blood sugar levels, while controlling cholesterol and blood pressure, is important for preventing diabetic macular edema.

Regular eye exams, including dilated eye exams, are also essential so your healthcare provider can monitor any changes in your vision and check for possible eye damage.

How often should I have an eye exam?

The American Diabetes Association recommends:

  • Adults with type 1 diabetes received initial mydriasis and a comprehensive eye exam within five years of diagnosis.
  • People newly diagnosed with type 2 diabetes will have eye exams shortly after diagnosis.

Those with normal tests and well-controlled blood sugar levels may have screening every one to two years. If diabetic retinopathy is present, a dilated retinal exam should be performed at least annually, and may be more frequent.

If you are pregnant, especially if you have diabetes, it is critical to have an eye dilation test during pregnancy and close monitoring if needed.

What is a diabetic eye exam?

generalize

Regardless of the type, people with diabetes are at higher risk for developing diabetic macular edema, especially if they already have diabetic retinopathy. Monitoring your eye health by undergoing dilated annual eye exams is essential to detect vision changes or damage to blood vessels that can lead to diabetic macular edema.

If you have been diagnosed with diabetic macular edema, there are treatments that can effectively treat the disease and protect your vision.

What is Diabetic Eye Disease?

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The onset of diabetic macular edema does not mean that you will lose your vision. There are effective therapies to treat and repair damage to the macula and blood vessels in the eye to prevent diabetic macular edema from becoming severe.

The key to preventing diabetic macular edema is managing your diabetes properly to avoid persistently high blood sugar levels. Controlling blood pressure and cholesterol levels can also help prevent diabetic macular edema.

If you notice changes in your vision or have concerns about diabetic macular edema, talk to your primary care provider. They can assess your condition and determine next steps to prevent or relieve diabetic macular edema.

Frequently Asked Questions

  • Will diabetic macular edema go away?

    While there is no cure for diabetic macular edema, damage to the macula can be treated and reduced to protect your vision. It’s important to maintain good blood sugar levels and follow a healthy lifestyle to prevent diabetic macular edema from getting worse.

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  • Is macular edema always caused by diabetes?

    While macular edema is usually caused by diabetes, there are other possible causes. For example, if you have eye surgery for conditions such as cataracts, glaucoma, or retinal disease, you may develop macular disease after surgery. Age-related macular degeneration and inflammatory diseases can also cause macular edema.

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  • Are bananas good for macular degeneration?

    Yes, bananas provide nutrients that can promote eye health and help prevent macular degeneration. These include folic acid and vitamin B6, as well as carotenoids, which are antioxidants that protect the eyes. A healthy fruit and vegetable diet will continue to promote eye health and prevent macular degeneration.

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