Multiple patient faces and eyes of all ages, genders, and ethnicities
Multiple patient faces and eyes of all ages, genders, and ethnicities

Diabetic Macular Edema

Diabetic macular edema (DME) is a complication of diabetes caused by an accumulation of fluid, protein and lipids throughout the layers of the retina, a layer of tissue in the back of the eye. The macula is the part of the retina responsible for sharp, straight-ahead vision. Fluid buildup causes the macula to swell and thicken, thereby causing blurred or distorted vision that can be severe. Diabetic macular edema is a result of another complication of diabetes, called diabetic retinopathy (DR), in which blood vessels in the eye are damaged, allowing fluid to escape.

Some people are at higher risk to develop DME than others. These include people with diabetes who:

  • Are of African American or Hispanic (particularly Mexican) heritage
  • Have poor glucose control
  • Have been living with diabetes for an increased length of time
  • Have high blood pressure
  • Have fluid retention
  • Have kidney disease
  • Show high fat levels in the blood (hyperlipidemia)
  • Are pregnant

Diabetes is now the leading cause of new cases of blindness in adults in the United States. Approximately 7.7 million Americans have diabetic retinopathy (DR) and, of those, about 750,000 also have diabetic macular edema (DME). As the number of people living with diabetes increases, so too does the number of people with impaired vision.

Symptoms of Diabetic Macular Edema

Patients who suffer from diabetes have a risk of developing DME over time. If you have diabetes, you should have your eyes examined regularly to help identify any eye health issues early. Be sure to mention if you notice changes in your vision such as:

  • Blurred vision
  • Wavy vision
  • Changes viewing colors (as if colors are washed out or faded)

Treatment for Diabetic Macular Edema

The most effective treatment strategies first look toward the underlying cause of macular edema, such as diabetes or high blood pressure, and then directly treat the damage in the retina.

In the recent past, the standard treatment for macular edema was focal laser photocoagulation. Recent clinical trials, however, have led doctors to move away from laser therapy to drug treatments injected directly into the eye. Treatments performed are aimed at maintaining vision for the patient and reducing future vision loss. You can discuss with your eye doctor which treatment is best for you:

Anti-VEGF Injections: Intravitreal injection is the current standard of care for macular edema. This is a procedure in which numbing drops are applied to the eye and a short, thin needle is used to inject medication into the eye’s vitreous gel. The injected medication blocks the activity of a substance called vascular endothelial growth factor (VEGF). Medications can reverse or stop abnormal blood vessel growth or the effects of inflammation in the eye. The anti-VEGF drugs all work in similar ways to block vessel formation and prevent leakage in the retina.

Anti-inflammatory Treatments:

  • Corticosteroid (steroid) treatments, which reduce inflammation, are often used for macular edema caused by inflammatory eye diseases. These anti-inflammatory drugs may be administered via eye drops, pills or injections of sustained-release corticosteroids into or around the eye.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), in the form of eye drops, are sometimes used either before or after cataract surgery to prevent the development of macular edema. NSAIDs may also be used when the eye doesn’t respond to steroid treatment or to avoid any side effects of steroid use in the eye.

Vitrectomy: When macular edema is caused by the vitreous pulling on the macula, surgery to remove the vitreous gel (vitrectomy) may be the best treatment option. This procedure may also be required to remove blood collected in the vitreous or to correct vision when other treatments have been unsuccessful. Most vitrectomy surgeries are performed outpatient (so that you get to return home the same day as the procedure).

If you have diabetes, you should have your eyes examined regularly to help identify any eye health issues early.