Diabetic macular edema (DME) occurs when fluid accumulates behind the macula, the part of your retina that processes central vision.

DME can occur at any stage of diabetic retinopathy (DR). However, it’s more common in advanced stages, such as proliferative diabetic retinopathy (PDR), a condition where high blood sugar levels damage the blood vessels in the retinas of your eyes. PDR is an advanced stage of DR.

DR and DME often occur with cardiovascular disease (CVD). In fact, if you live with diabetes and are experiencing changes to your eye health as a result, your doctor might suggest regular cardiac screening to prevent heart disease.

It’s estimated that about 1 in 15 people living with diabetes will go on to develop DME.

Initially, DR occurs when high blood sugar damages the blood vessels in your retina. This can lead to blood vessel changes such as:

  • leakage
  • swelling
  • blockage
  • new and abnormal blood vessel growth

Sometimes the fluid that leaks from the damaged vessels accumulates in the retina and causes it to swell. This retina swelling is DME.

In addition to vascular changes, there’s also research that suggests inflammation plays a role in the development of DME.

The blood vessel changes that cause DME are also connected to CVD. The leading cause of death for people living with diabetes is cardiovascular disease (CVD), which includes myocardial infarction (MI) or heart attack. An MI damages part of your heart muscle from a lack of blood flow.

A 2017 review involving 7,604 people living with type 2 diabetes (T2D) found that participants with DME or PDR had an increased risk of developing heart disease.

Research suggests that it’s the diabetes-related blood vessel damage that connects DME and CVD. This type of vascular damage can impact organs throughout the body, including:

  • eyes
  • heart
  • brain
  • nerves
  • kidneys

Blood vessels circulate oxygen and nutrients to organs and tissues and carry away cellular waste. When blood vessels incur damage, they can’t perform these essential functions. This can result in injury to organs like your eyes and heart.

Other factors that increase your chance of heart disease with T2D include:

  • excess body weight
  • high blood pressure
  • high cholesterol

If you live with T2D and DME, it’s worth asking your doctor about CVD screening. Even if your blood sugar is well controlled and you aren’t experiencing eye health issues, talking with your doctor about the link between DME and CVD can be informative and help you take steps to reduce your risk.

Assessment tools doctors use for cardiac screening include:

  • exercise stress test
  • resting electrocardiogram (ECG)
  • echocardiogram
  • nuclear stress imaging
  • coronary artery calcium scoring
  • coronary computed tomography angiography

Screening is particularly beneficial for people living with T2D since they are more likely to experience heart problems without recognizable symptoms, such as silent MIs.

You can reduce your chance of developing both diabetes-related eye damage and heart disease by keeping your blood sugar within the range your doctor recommends.

While this isn’t always easy, the more time your blood sugar is in range the less chance you’ll have of experiencing diabetes effects like DME and CVD.

Asking questions and educating yourself about diabetes is an important step. Managing blood sugar is easier when you have relevant information, such as:

  • the carbohydrate content and glycemic index of the foods you eat
  • the impact fiber, fat, and protein have on your blood sugar
  • the factors that affect insulin sensitivity (how well insulin works)
  • the effects of exercise, hydration, and sleep

Making some changes to your diet and lifestyle may be enough to keep your blood sugar well controlled. These changes can include:

  • reducing your carbohydrate intake
  • switching to water as your main beverage
  • aiming for more physical activity each day
  • maintaining a consistent sleep schedule
  • practicing stress reduction strategies

Medication adherence can also improve your blood sugar levels. Whether that medication is oral like metformin or an injectable type of insulin, following your doctor’s instructions for dose and timing can improve the effects on your blood sugar.

DME and CVD are both treatable.

In the early stages of DME, you might not experience vision changes. Your doctor might suggest waiting to begin treatment and monitoring your condition.

Improving your blood sugar control may slow or stop the progression of early-stage DME. Effective blood sugar management can also prevent heart disease.

Once DME starts to affect your vision, treatment options include:

  • Anti-VEGF therapy: Anti-VEGF medication blocks the activity of vascular endothelial growth factor (VEGF). This therapy slows the growth of new blood vessels, reduces the progression of vision loss, and may even improve vision.
  • Corticosteroids: This type of medication reduces swelling and inflammation.
  • Laser therapy: Doctors use laser pulses to seal the leaking blood vessels in your eyes.
  • Surgery: Vitrectomy is surgery to remove the blood-filled vitreous fluid from inside the eye and replace it with saline or a similar substance.

Heart disease treatment options depend on the severity of the condition, but can include:

  • Lifestyle changes: Exercise, diet, stress reduction, and smoking cessation are examples of lifestyle changes that can improve heart health.
  • Medications: Doctors can prescribe medications that lower blood pressure, control plaque buildup, reduce pain, or lower cholesterol.
  • Surgery: Stent implants and grafts are examples of surgical interventions that can treat heart disease.

The outlook for both DME and CVD depends on several factors:

  • how early doctors identify each condition
  • how well the conditions respond to treatment
  • how well you manage your blood sugar
  • other aspects of your health, such as blood pressure and cholesterol levels

Untreated DME can result in vision loss, and at least 50% of people with diabetes die as a result of heart disease. But treatment can change these outcomes.

A 2022 study found that intensive control of blood sugar can reduce the need for laser surgery and slow the progression of DME.

Cardiac screening for early detection of CVD can reduce the chance of MI and heart failure.

Persistent high blood sugar from diabetes can lead to other conditions like heart disease and eye damage.

If you live with diabetes and DME, you have a higher chance of developing heart disease than someone without DME.

Although DME and heart disease are both potentially serious, they’re also both treatable. Your doctor can screen for heart disease to catch it early and make treatment more effective.