What Is Diabetic Macular Edema (DME)?
Key takeaways:
Diabetes can affect the eyes and cause vision problems.
Diabetic macular edema (DME) is a type of diabetes-related swelling in the back part of the eye that can cause vision loss.
If you have diabetes, you should get your eyes checked at least once a year to make sure you don’t have DME or other diabetes-related eye conditions.
Diabetes can affect all the organs of the body, including your eyes. One of these conditions of the eyes is called diabetic retinopathy, which causes damage to the small blood vessels in the eyes. Diabetic retinopathy can lead to complications like diabetic macular edema (DME).
Studies show that more than 7 million Americans have diabetic retinopathy, and about 10% of these people have diabetic macular edema. If you’ve been diagnosed with DME, see below for everything you need to know to keep your eyes healthy and your vision safe.
What causes macular edema in people living with diabetes?
Diabetic macular edema (DME) is a complication of diabetic retinopathy. Over time, high blood sugar can cause inflammation of the blood vessels in your body, including the ones in the retina (the part of the eye that lets our eyes and brain interpret images).
If the inflammation isn’t taken care of, it will cause the blood vessels to break down and leak fluid. The fluid starts to accumulate in the retina and causes the macula (the part of the retina that controls your central vision) to swell. Like anything else that gets stretched out, the macula can't do its job properly when it’s swollen and stretched out of shape. That’s why people with DME have trouble with their central vision.
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Is diabetic macular edema serious?
Yes. DME is a serious condition that needs to be treated by a specialized ophthalmologist called a retinal specialist.
If DME isn’t treated properly, it can cause permanent vision loss, including blindness.
What are some symptoms of diabetic macular edema?
Symptoms of diabetic macular edema include:
Blurry vision
Wavy vision
Washed-out colors
Missing parts or “blocked parts” when looking at something
The symptoms can happen in one or both eyes. These symptoms will be most noticeable in your central view, not in your peripheral view.
How often should I see my ophthalmologist?
Regularly. Consistent visits to your ophthalmologist are extremely important if you have diabetes, especially if you have diabetic retinopathy.
Early on, people with diabetic retinopathy don’t have any symptoms. With early detection and treatment, complications like DME can be prevented, and your vision can remain safe and clear.
If you have diabetes, you should see an ophthalmologist once a year. If you already have DME, you will see your ophthalmologist a few times a year.
What are my options for diabetic macular edema treatment?
When treating DME, it’s important to also treat diabetes and diabetic retinopathy. Unless all three are under good control, your vision could still become damaged.
In addition, your retinal specialist will recommend a specific treatment plan for diabetic macular edema. Some options include:
Anti-VEGF injections
These injections are a primary treatment for DME. Vascular endothelial growth factor (VEGF) is a substance that promotes the growth of blood vessels. This is normally not a problem, but, in people with diabetic retinopathy, this substance can cause blood vessels to grow and subsequently leak more fluid. Anti-VEGF drugs block VEGF so blood vessels stop growing. The most common anti-VEGF medications include:
These medications are given as an injection. Your ophthalmologist will numb your eye so you won’t feel pain during the injection. Sometimes people may notice blurred vision after the injection, but this should only last a short time. Most people get these injections once a month. If you have a good response, injections can be spaced out.
Focal laser therapy
Before anti-VEGF injections were available, focal laser therapy was the treatment of choice for DME. It works by creating a microscopic burn on the blood vessels so they stop leaking and don’t keep growing.
Laser therapy isn’t painful, but it doesn’t work as well as anti-VEGF injections for many people. It is sometimes used in combination with other treatment options including anti-VEGF injections.
Anti-inflammatory implant
Iluvien is a steroid implant that has been approved to treat diabetic macular edema. It works by decreasing inflammation in the retina, which can help decrease leakage. Your ophthalmologist inserts the implant into the back of your eye through surgery.
Implants can be effective for up to 3 years and dissolve over time. Steroid implants do carry risks of complications, including cataract development. They also don’t work as well as anti-VEGF injections, so they aren’t a first choice.
The bottom line
Diabetic macular edema (DME) is a complication of diabetic eye disease, and it can lead to permanent vision loss and blindness. There are treatment options for DME, including injections, implants, and laser therapy. But if you have diabetes, the most important thing you can do to care for your vision is to prevent DME from starting. Make sure you get regular eye checks if you have diabetes, and, if you notice any changes in your vision, see your ophthalmologist right away. Catching DME early can keep your eyesight safe.
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References
Distefano, L. N., et al. (2017). Combination of anti-VEGF and laser photocoagulation for diabetic macular edema: A review. Journal of Ophthalmology.
National Eye Institute. (2019). Macular edema.
Prevent Blindness. (n.d.). Diabetes-related macular edema.
Prevent Blindness. (2015). Diabetic macular edema (DME).
