What Is Diabetic Macular Edema?
When you have diabetes, you have a lot to manage. High blood sugar can lead to other conditions, like eye problems.
One of the most common ones is diabetic macular edema. It's serious and can rob you of your vision.
That's a scary possibility, but knowing what to look out for and getting the right treatment can help protect your sight.
Even if you don't notice problems, when you have diabetes it's important you get your eyes checked every year. If you do have a problem, see an eye doctor right away. Your eye doctor may refer you to an ophthalmologist who specializes in the retina and can provide treatment. If you catch it early, there's a chance you can stop long-term damage.
High blood sugar weakens the blood vessels in your eyes. That can make them leak or grow out of control in your retina, the light-sensitive area at the back of your eye. This is called diabetic retinopathy.
When fluid seeps into your retina, it can cause diabetic macular edema. The leaking makes your retina swell, which hampers the work of your macula, the special, sensitive part that gives you sharp vision.
Diabetic macular edema doesn’t always cause symptoms.
But you may:
- Have images directly in front of you appear blurry or wavy
- See colors that seem “washed out”
If this happens to you, see your doctor right away.
Getting a Diagnosis
Before any testing, your doctor may ask you questions:
- Have you noticed changes in your vision? If so, what kind?
- Have you been diagnosed with diabetes? If so, when?
- Does anyone in your family have it?
- How have your blood sugar and A1c levels been lately?
- Do you have high blood pressure or high cholesterol?
- Do you have any other medical conditions?
You will need a thorough eye exam, which usually includes:
- A visual acuity test. It checks how well you see at different distances.
- A dilated eye exam. Your doctor will use drops to widen your pupils and look at the inside of your eyes. They'll look for signs of disease, including damaged or leaking blood vessels, swelling, and fatty deposits on the retina.
If your doctor thinks you have diabetic macular edema, you may also need one or both of these tests:
- A fluorescein angiogram (FA) takes pictures of your retina using a special dye that helps find any leaking blood vessels. The dye is injected into your arm, but travels quickly to your eye.
- Optical coherence tomography (OCT) uses a special camera to photograph your retina. It is very sensitive and can find even small amounts of fluid and swelling.
Questions for Your Doctor
- What is causing my symptoms?
- Will I lose my sight?
- Am I at risk for other eye diseases?
- Do you have experience treating diabetic macular edema?
- What type of treatment do you recommend for me?
- What can I expect from it?
- What else can I do to protect my vision?
- How often will I need to have my eyes checked?
To treat diabetic macular edema, doctors may use drugs that are injected into your eyes to help stabilize the new blood vessels and stop leaking. They also slow the growth of new blood vessels. The drugs they will use are Anti-VEGF medications.
VEGF and Ang-2 are proteins that can lead to vision loss in people with DME. They cause the growth of abnormal and fragile blood vessels. Most treatments target and block only VEGF.
The main drugs include:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Fluocinolone acetonide (Iluvien)
- Ranibizumab (Lucentis)
Angiopoietin-2 is another protein involved in blood vessel formation. Ang-2 inhibitors help stabilize these fragile new blood vessels so they don't leak.
VEGF/Ang-2 inhibitors include:
- Faricimab-svoa (Vabysmo)
In severe cases, you may also have laser photocoagulation. A doctor will use a tiny laser on your eye to seal leaking blood vessels. You may need more than one treatment to control the problem. It's usually not painful, but you may have a slight stinging feeling when the laser touches you.
Sometimes steroid injections may help.
Another treatment is a surgery called vitrectomy. This is usually done because of bleeding (not macular edema), and doctors take out the fluid that is clouding your vision and replace it with a clear solution.
Taking Care of Yourself
There’s a lot you can do to prevent your condition from getting worse. First, manage your diabetes by controlling your blood sugar, blood pressure, and cholesterol.
Diet changes, keeping a healthy weight, and exercise can all help you manage these problems. Talk with your doctor about the best way to do this.
Also, don’t sidestep regular eye exams. Symptoms can sneak up. Your doctor needs to see you to keep track of how your treatment is working.
Have you already lost some vision? Talk to your doctor about visual aids, like magnifying glasses, if eyeglasses alone aren't enough. Ask them about resources in your area that can help you learn skills for living with vision loss.
What to Expect
Treatment can help you protect your vision. It can greatly decrease your chance of losing your vision.
Stay on top of your diabetes, and stick with your treatment plan. You'll have the best chance of maintaining your sight and staying independent.
For more information about the eye conditions related to diabetes, go to the web site of the American Diabetes Association. They have links that can help you get the support you need.