Diabetic Macular Edema (DME) — What You Need to Know

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Medical review by Elizabeth Gomez MSN, FNP-BC

Macular edema is the most common cause of vision loss among people with type 1 and type 2 diabetes. This occurs when hyperglycemia and other metabolic dysfunction cause swelling of the macula, part of the retina used for the highest quality vision.

There is no treatment for diabetic macular edema, but it does not always get worse. Treatment can also significantly slow its progression. For those who have already experienced a decline in vision, it may be possible to reverse the damage before treatment can last.

This article provides more information about Diabetic macular edema (DME): What is that and what does that mean to you?

I have diabetic macular edema. Will I be blind?

This tragic question is in the online diabetic community. thrivedailywellness.

noMacular edema does not always lead to blindness. There is no treatment for diabetic macular edema, but some cases improve naturally and there are a variety of treatments that can slow and stop its progression. Some people can reverse vision damage before it becomes permanent.

Many members of our community have lived with DME for years. Some require regular injections of special drugs. Others have emerged from early courses of eye therapy with improved vision and are now relying on metabolic control to prevent the condition from worsening.

Without a doubt, DME will definitely need treatment, even if your vision seems to be going well right now. Medicines developed for DME not only improve vision in the short term, but also prevent further permanent damage. Without proper treatment, DME can lead to severe visual impairment, although focusing on both eye and metabolic health.

Another thing is very clear. Even the most advanced DME therapies rely on excellent diabetes management for lasting success. DME, like other diabetic complications, is essentially caused by hyperglycemia. Good blood glucose control – along with weight loss, healthy blood pressure, and other improved metabolic parameters – It will significantly determine your prognosis.

Diabetes and eye complications

The eyes are like that One of the most vulnerable parts of the diabetic body. The retina – the part of the eye that actually senses light and sends signals to the brain – has many small veins that are particularly sensitive to hyperglycemia. When they are exposed to chronically elevated blood glucose levels, these small veins will expand, rupture and leak. Other metabolic factors, including high blood pressure and high cholesterol, contribute to the risk.

Other parts of the eye are also at increased risk of diabetes harm, including lenses (cataracts) and optic nerves (glaucoma). However, the retina suffers most from damage. This is widely known when diabetes causes retinal dysfunction Diabetic retinopathy.

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If you see an ophthalmologist regularly – recommended by the American Diabetes Association Annual Expansion Eye Examination – You may be able to identify and deal with diabetic retinopathy long before you notice a decline in vision.

However, not everyone is that lucky, and for some, diabetic retinopathy causes macular edema. This is a condition that requires rapid treatment to prevent permanent vision loss. Macular edema can also occur at any stage of diabetic retinopathy even in previous stages, but is more likely to occur after the condition has progressed to an already more severe condition.

What is diabetic macular edema?

The macula is a particularly important part of the retina, located at the center of the retina, and the lens focuses most of the light entering the eye. The macula is used in the direct centre of our highest quality and sharp vision, namely good lighting vision. When your eyes focus on your face, books, or TV screen, the light is focused on your macula. Naturally, damage to the macula can have a significant impact on the quality of your vision.

Macular edema in diabetes occurs when leaking blood vessels causes swelling in the macula. The swelling disrupts healthy vision.

Macular edema is not caused by diabetes alone. Other causes Includes age-related macular degeneration, retinal pigmentitis, uveitis, and side effects of ophthalmic surgery.

How common is DME?

a 2012 Analysis Of data worldwide, it suggests that around 7% of diabetic patients have DME. However, only minorities have experienced severe vision loss or blindness. World Health Organization estimate 3.9 million people worldwide suffer from “moderate or severe distance vision loss or blindness” due to diabetic retinopathy. It is less than 1% of people in the world with diabetes.

The risk of DME is higher for people with type 1 diabetes and for people with type 2 who use insulin. Another analysis confirms that it may develop DME It will increase dramatically Long periods of diabetes and high levels of hyperglycemia.

Also, some evidence suggests that black Americans are more likely to develop DME than white Americans and are more likely to suffer from severe consequences such as blindness. It is unclear whether this difference is due to genetic factors or the result. Systematic racial disparities It plagues modern American healthcare. In any case, black readers (or black caretakers of diabetics) should be aware that their risks may increase.

DME symptoms

Ideally, DME is diagnosed during daily eye examinations before symptoms become noticeable.

If it’s been a while since you’ve seen an ophthalmologist and are wondering about changes in your vision, you should schedule an appointment as soon as possible.

The early stages of macular edema are generally characterized by blurred vision. According to National Associationyou may also notice:

• The object looks wavy, especially when you look straight
• Objects appear different sizes when viewed from one eye and the other eye
• The colour looks dull or faded

Continuing development of macular edema can ultimately lead to severe central vision loss. Some patients may retain some of their surrounding vision, but it can be difficult to read, drive, or even recognize the face of the person you are talking to.

DME diagnosis

I recommend that anyone with diabetes have an annual Extended eye examination. This is not just a check of vision quality to update the correction lens prescription, but it can usually be done on the same visit. In an expanded eye examination, an ophthalmologist (ophthalmologist) can apply the solution to the eye, dilated or enlarged the pupil, allowing you to see the inside of the eye more clearly.

Many doctors also use optical coherence tomography (OCT) to examine the surface of the retina. This non-invasive test allows ophthalmologists to see the retina in different layers and measure the thickness.

If you have evidence of retinopathy, your ophthalmologist may do it Fluorescein angiography Identify which part of the eye is liquid. This test involves injecting a special dye into the arm to emphasize the blood of the eye.

If your doctor sees evidence of macular edema, he may also ask you to look at metabolic health measures, such as A1C, blood pressure, and lipid profile. This helps to connect eye problems to diabetes.

Traditional vision tests can help you determine the degree to which your vision is already deteriorating or not worsening.

I have a DME. What happens next?

Some DME cases I will resolve it spontaneously Without treatment, it may recur later. Nevertheless, I hope you are one of the lucky minorities. Diabetic macular edema should be handled as soon as possible. Here’s a review of the options:

Glycemic control and metabolic risk factors

The first line of defense against DME is to improve risk factors for diabetes and metabolism. Putting A1C, blood pressure and cholesterol within the recommended range is the main way to directly address the root causes of diabetic eye disease. the study Improvements in these factors indicate that “macular thickness can have measurable effects in just six weeks.”

Unfortunately, ophthalmologists “do not emphasize the importance of these risk factors very often.” Perhaps they don’t want to step on the toes of primary care physicians or endocrinologists who usually advise patients on such issues.

If you have been diagnosed with DME, this is a great opportunity to renew your commitment to diabetes management. A healthy diet, exercise and wise use of glucose-lowering medications will help you maintain your vision for years to come. You may be able to advise new lifestyle changes and medications to strengthen your diabetes management efforts, so you should make sure your primary care physician is well-informed about your vision.

injection

Not all DME cases require immediate intervention. If you do, the first line of treatment is a series of injections with anti-vascular endothelial growth factor (anti-VEGF). This drug helps to control swelling in the macular and block abnormal blood vessel growth.

These injections will be sent directly to your eyes. So yes, the doctor inserts the needle into the eyeball. We are, and of course, a lot of people in the diabetic community are afraid of this idea. However, these injections are the best treatment for this condition. I’ve also heard that injections aren’t so bad that they can hear. It’s uncomfortable, but not actually painful. Your doctor will apply numb medication in your eyes and the needle is very small. The injection ends quickly and does not need to recover. You will likely be able to quickly return to your normal activities.

The standard treatment for anti-VEGFS is the first course of six monthly injections, with many follow-up injections based on the effectiveness of the initial treatment. According to American Academy of Ophthalmology“On average, patients receive 6-8 injections in year 1, 2-4 injections in year 2, and 0-1 injections in year 3.”

Unfortunately, these drugs don’t work for everyone. A significant few patients continue to experience worsening DME.

If anti-VEGF is not effective, your doctor may add an injection of corticosteroids. These drugs may strongly reduce inflammation and may interfere with the progression of anti-VEGF therapy. In most cases, these steroid injections can also lead to cataract development, which may require other surgery in the future.

Laser photosolidification

Laser therapy was once the standard therapy for DME, but in the US it has been largely replaced by anti-VEGF injections. This somewhat invasive technique may be used in conjunction with injections in a subset of DME patients with a specific pattern of retinal thickening, or in patients with ineffective anti-VEGF treatment. Laser treatment is still preferred in resource-restricted regions around the world. In this procedure, after using a paralysis agent, the laser is pointed at the eye, sealing or shrinking leaky blood vessels in the retina. Patients may need multiple laser treatments.

Laser photocoagulation is associated with significant risks, including loss of peripheral, colour and night vision, but trade may be valuable to those at risk of losing central vision.

Surgery

Finally, your doctor may recommend vitrectomy. Vitrectomy removes much of the vitreous humor (clear gel that fills the eyes). Vitrectomy is a more invasive procedure than the shots and laser treatments mentioned above. A general anesthesia may be required, and only one eye can perform surgery at a time.

It is unclear how effective vitrectomy is for DME, so its use may be limited to patients with other eye problems in addition to DME such as vitreous traction syndrome. Like any other surgeries, there is a risk of complications.

If you require more details on all of the above methods, it is outlined in the official Treatment Guidelines for Diabetic Macular Edema. Created Document According to the American Academy of Ophthalmology. this Simple English explanation It might be even more useful.

Take home

Diabetic macular edema (DME) is a serious eye complication that affects people with diabetes. The more diagnosed and treated previous DME, the better the outcome is, and this is another reason why people with diabetes regularly see an ophthalmologist. If you (or your loved one) have recently experienced a decline in vision, you should assess your eye health as soon as possible.

In some cases, DME can lead to serious visual impairment. However, most people with this condition have a more favorable prognosis, especially when seeking treatment as soon as recommended. In many cases, treatment reverses the vision damage caused by DME.

DME is caused by other metabolic dysfunctions, essentially high blood sugar and diabetes. The success of treatment may combine both targeted eye health therapy with improved diabetes management, such as closer glycemic control.