Diabetic Macular Edema: What You Need to Know

Diabetic macular edema (DME) is a complication of diabetes. People with type 1 or type 2 diabetes can develop DME.

DME occurs when excess fluid starts to build up in the macula of the eye. The macula allows us to focus and see fine details. It’s located in the center of the retina, the lining at the back of the eye that’s full of blood vessels.

When excess fluid builds up in the macula, it causes vision problems.

DME generally develops over time. High blood sugar levels can damage the blood vessels in the retina. Damaged blood vessels can leak fluid, which causes swelling and other issues. This damage is called retinopathy.

There are several treatment options for DME. It’s easiest to treat when diagnosed early and monitored regularly by an eye care doctor.

There are effective treatments available for DME. Annual eye exams can detect any changes early. If you have DME, treatments can protect your eyesight and may reverse vision loss.

Your eye care doctor may recommend using more than one type of treatment.

Laser therapy

This therapy option is usually offered in a clinical setting, such as your eye care doctor’s office.

Laser therapy uses tiny lasers to target damaged areas in the retina. This process seals leaking blood vessels and prevents abnormal blood vessel growth.

Laser therapy can help maintain your current vision level and prevent further loss of vision.

You’ll likely need several laser treatments over time to repair eye damage. You may need additional treatments if more eye damage occurs.

Injectable medications

There are two groups of injectable medications: anti-VEGF and steroids. Within each group, there are several types available.

Your eye care doctor will determine the specific medication and frequency of treatment that’s right for you.

Your eye care doctor injects the medication into your eye with a very thin needle. They will numb your eye to prevent any pain when they give this medication.

Anti-VEGF stands for “anti-vascular endothelial growth factor.” Medications in this category help prevent abnormal blood vessel growth that could further damage the eye. They also reduce swelling.

In general, anti-VEGF medications:

• show good success in improving vision, according to recent research
• help reduce the amount of fluid that leaks into the retina
• have a low risk of complications and are considered safe

Anti-VEGF injections aren’t usually painful. If needles make you anxious, you can talk to your doctor about options to help you feel calm during the procedure.

Steroids are another option to treat DME. Steroids may:

• help reduce swelling of the retina and improve vision
• be used if anti-VEGF medications no longer work

However, steroids may increase the risk of cataracts in some cases. Your doctor will discuss whether the benefit of using this therapy outweighs the risk.

Steroid treatment for DME may be available as single injections or implants that release the medication over time.

In its early stages, there may be no symptoms. If you have diabetes, it’s important to see an eye care doctor every year so they can examine your eyes for any changes. If there’s any sign of retinopathy or DME, early treatment can prevent or restore vision loss.

Make sure to tell your eye care doctor if you have any of the following symptoms:

• blurry vision
• seeing colors that look washed out
• seeing more floaters in your vision
• double vision

Over time, high blood sugar levels can damage small blood vessels in the eyes, increasing the risk of DME.

Working with your healthcare team to keep your blood sugar levels as close to target as possible is a key part of keeping your eyes healthy.

High blood pressure and high cholesterol levels can also contribute to blood vessel damage.

In some cases of diabetes, pregnancy can increase the risk of developing DME. Your doctor may recommend more frequent eye exams during pregnancy.

DME is sometimes classified based on the amount of swelling seen in the retina. A thicker retina means there’s more swelling, and this usually means greater vision loss.

It may also be defined by the location of damage to the blood vessels. In some cases, it’s confined to one area. In other cases, the damage is more widespread throughout the retina.

When you have an eye exam, your eye care doctor may perform several tests on your eyes. The tests assess any vision loss and show any damage to blood vessels or amount of fluid buildup (swelling) in the retina.

Common eye tests to screen for DME or assess eye damage are:

• Optical coherence tomography (OCT). This test measures any swelling in the retina.
• Fundus imaging. This test takes detailed pictures of the retina to look for irregular blood vessels.
• Fluorescein angiography. For this test, dye is injected into your arm or hand to highlight the blood flow in the retina.

For all tests, you’ll be given eye drops to make your pupils larger (called pupil dilation). This allows your eye care doctor to see more of the retina.

Other than some light sensitivity from the pupil dilation, you won’t feel any discomfort during the testing.

When caught early and monitored by an eye care doctor, treatment can help prevent further loss of vision. Treatment may even restore lost vision.

Left untreated, vision can significantly worsen in the span of a few months.

For people with type 1 or type 2 diabetes, there are additional risk factors that can lead to DME. These risk factors include:

• poor blood sugar management
• high cholesterol
• high blood pressure
• kidney disease (nephropathy)
• sleep apnea
• pregnancy

It’s never too late to discuss treatment options with your doctor. If you’ve received a diagnosis of DME, starting treatment quickly can help prevent long-term eye damage and vision loss.

Taking preventive action can make a big difference when it comes to protecting your vision. Help take care of your eyes by doing the following:

• See your eye care doctor for annual checkups.
• Contact your eye care doctor as soon as you notice any vision changes.
• Work with your diabetes care team to manage your blood sugar levels effectively.
• Take steps to keep your blood pressure and cholesterol levels in target.

If you’re finding it difficult to manage your blood sugar, let your healthcare team know. They may recommend lifestyle changes, medication, or other steps that can help you keep your blood sugar levels in a healthy range.

Diabetic macular edema (DME) is a manageable condition. Several effective treatment options are available. Maintaining eyesight or recovering lost sight is possible.

Seeing your eye care doctor at least every year is an important step in taking care of your eyes and overall well-being. Early detection is the best way to prevent vision loss.