What Is Diabetic Macular Edema (DME)?

In people with uncontrolled diabetes or fluctuating levels of blood sugar levels, the inner lining of the blood vessels is damaged.

• This weakens the tiny blood vessels in the retina and causes leakage of fluids in and around the macula.
• The damaged blood vessels and micro-aneurysms (tiny bulges) begin to build up pressure that causes edema (swelling) in the macula part of the retina, leading to diabetic macular edema (DME).

DME is a serious eye complication that obstructs the function of the macula, distorting vision.

The 2 types of diabetic macular edema (DME) include

1. Focal DME: Small spots of fluid leakage occur due to irregularities in the blood vessels in the eye.
2. Diffuse DME: Leaks and swelling occur throughout the macula due to swelling of the retinal capillaries. The eyesight of a person with diffuse DME may be seriously affected.

Risk factors for DME

DME progresses over time in people who have diabetes. Risk factors that can increase the risk of DME in people with diabetes include

• Diabetes that is uncontrolled for a long period
• High blood pressure
• High cholesterol
• Hyperlipidemia (high levels of fats)
• Hypoalbuminemia (low levels of protein)
• Kidney disease
• Pregnancy
• Sedentary lifestyle
• Sleep apnea
• Smoking
• Untreated diabetic retinopathy

Diabetic macular edema (DME) doesn’t always cause symptoms in the early stages. A person with diabetes should have their eyes examined every year to help identify any signs of retinopathy or DME.

Some of the common symptoms of DME include:

• Blurred vision
• Colors appear faded or washed out
• Double vision
• Floaters in the vision
• Wavy vision

If the above symptoms appear, the person must see the doctor right away. Sometimes, symptoms may not be noticed if a person has DME in only one eye.

Treatment of diabetic macular edema (DME) aims at maintaining the vision of the patient and preventing future loss of vision.

Bringing sugar to normal levels can help reverse some swelling. Starting treatment early as soon as the diagnosis is made can help prevent long-term eye damage and vision loss.

When left untreated, within a few months, vision can significantly worsen, and eventually, blindness may occur.

One or more of the following treatments may be recommended by the doctor to treat DME:

• Laser treatment: Tiny lasers are used to target and seal the leaking blood vessels, preventing fluid from entering the macula. Several laser treatments may be required to repair eye damage. Laser treatment helps maintain current vision and prevent further loss of vision.
• Injectable medications: There are two types of injectable medications, namely, anti-vascular endothelial growth factor (anti-VEGF) injections and steroid injections. The ophthalmologist would decide on the specific medication and regularity of treatment that’s suitable for the patient.
  • Anti-VEGF injections: Anti-VEGF medication is injected into the vitreous gel (the fluid in the center of the eye) using a short thin needle after applying numbing drops to the eye. Medications block the activity of VEGF and help stop leaking, stop the abnormal growth of the blood vessels, reduce swelling in the eye, and improve vision.
  • Steroid injections: Sometimes, steroid injections may be used to help reduce swelling of the retina and improve vision if anti-VEGF medications are no longer effective. Steroid treatment may be provided as a single injection or implants that release the medication over time. However, because steroids may increase the risk of cataracts in some patients, the doctor will evaluate whether the benefit of using steroids outweighs the risk involved.

Taking the following measures can help prevent diabetic macular edema (DME) and protect the vision.

Preventive actions include:

• Visit the eye doctor at least one time a year for checkups
• Maintain blood sugar levels in the recommended range
• Maintain blood pressure and cholesterol levels
• Maintain a healthy lifestyle
• Exercise regularly
• Eat plenty of vegetables and fruit