Diabetic macular edema is a leading cause of vision loss in people with diabetes. If you’ve been diagnosed with this eye disease, you need to know which options can protect your sight.
If you’ve recently been diagnosed with diabetic macular edema, or DME, you may be wondering how your condition will progress. Although diabetic eye diseases, including DME, are the leading cause of irreversible blindness in working-age Americans, according to the National Eye Institute (NEI), there are steps you can take to treat this diabetes complication and prevent further vision loss. Use this guide to learn more about DME.
What Is DME?
People who have type 1 or type 2 diabetes may develop a complication called diabetic retinopathy, or damage to the small blood vessels of the eye’s retina. DME occurs when fluid from these damaged blood vessels leaks into the macula, an area in the center of the retina that helps us see objects directly ahead of us, and causes swelling.
The primary risk factor for diabetic retinopathy and eventual DME is uncontrolled blood sugar. Having high blood pressure or high cholesterol may also increase your risk of vision loss if you have DME, according to the NEI.
Prevent Blindness, a patient advocacy organization for healthy vision, says that as many as 10 percent of people with diabetes also have DME. Given that some 30 million Americans have diabetes, this means vision loss associated with the condition may be fairly common.
While diabetic retinopathy often advances slowly, DME can progress much faster, says Daniel S. Casper, MD, PhD, an ophthalmologist with Columbia University Irving Medical Center in New York City. At first you might not experience many symptoms, but eventually your central field of vision could become wavy and blurred, he adds.
“As fluid builds up in [the center of the macula], the retina becomes boggy, reducing the ability to focus,” Dr. Casper explains. Some people say that letters and shapes look twisted or misshapen, he adds.
How Is DME Diagnosed and Monitored?
Technology has completely changed how DME is detected, says Casper. Today, your ophthalmologist will use a noninvasive test called optical coherence tomography (OCT) to measure the thickness of the retina using light, he says. The test detects whether someone needs to be treated for DME and then, if treatment is prescribed, whether the treatment is working.
“There’s a certain amount of urgency with getting people with DME evaluated and treated,” says Casper. “The sooner [DME] is identified and treated, the better a patient does. If you wait until your vision is impacted, you may not get back all of your sight.”
How Is DME Treated?
If you’ve been diagnosed with DME, one of the most important steps you can take is to lower your hemoglobin A1C level, the measure of your blood sugar average during a three-month period. Lowering your A1C can help slow the advancement of DME and protect your vision, says Casper.
Your doctor may suggest eye treatments as well. Up until relatively recently, explains Casper, the only option was laser treatments, which seal off capillaries to stop leakage, but now eye injections are available that stymie blood vessel growth and leakage.
Your doctor may recommend injections of corticosteroids, which are used to reduce inflammation in the eye to stop leakage, or anti-VEGF drugs, which are designed to block the accumulation of vascular endothelial growth factor (VEGF), a type of protein that produces new blood vessels in the eye. By blocking VEGF, these drugs work to reduce the swelling in the eye that causes DME.
Both types of drugs can be delivered by regular injections over the course of many years, explains Casper, or a surgeon may implant a small capsule in the eye that is designed to provide doses of them as needed.
A Cochrane Library review published in October 2018 found that anti-VEGF treatment can be an effective treatment people with DME. You should always work with your doctor to find the right treatment for your DME, Casper says, be it lasers, injections, or both.
The bottom line: If you have DME, don’t wait to seek help. “You can stop the progression of the disease, but often, only minimal — if any — lost vision can be restored,” Casper explains.