One of the complications of diabetes is diabetic retinopathy, which is an eye condition that can cause vision loss and blindness. Diabetic retinopathy occurs as a result of high blood sugar levels that damage the blood vessels in the retina (the light-sensitive tissue in the back of your eyes). Early detection and treatment can prevent blindness, which is why it’s so important to have dilated eye exams at least once a year.
You might not be as familiar with the term “macular edema.” According to the National Eye Institute, “Macular edema is the build-up of fluid in the macula, an area in the center of the retina.” The macula is responsible for sharp, straight-ahead vision; the presence of fluid in the macula causes it to swell and thicken, leading to distorted vision.
Macular edema can result from a number of conditions, such as:
- Eye surgery
- Trauma to the eye
- Inflammatory eye diseases, such as uveitis
- Age-related macular degeneration (AMD)
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Diabetic macular edema
When macular edema results from diabetes, it’s called diabetic macular edema, or DME. This condition can affect people with either type 1 or type 2 diabetes; it’s estimated that up to 10% of people with diabetes will get DME, according to the website www.preventblindness.org
DME is more likely to occur as diabetic retinopathy progresses, although it can happen at any stage of diabetic retinopathy. It’s the most common cause of vision loss in people with diabetic retinopathy, too. In addition to high blood sugars, other risk factors for DME include:
- Long duration of living with diabetes
- High blood pressure
- Kidney disease
- High blood fat levels
Symptoms of DME
You may not have any symptoms in the early stages of DME. Again, this is why it’s so important to keep up with annual dilated eye exams so that your eye care specialist can check your eyes for any changes.
Typical symptoms of DME are:
- Blurry or wavy vision
- Double vision
- Colors that appear faded or washed out
- Difficulty reading
There are several tests that might be used to determine if you have DME.
Visual acuity test
This test involves using a chart of letters that decrease in size from top to bottom.
This is a simple test, using a grid, to see if your central vision has changed or not.
Dilated eye exam
Drops are placed in your eyes to dilate the pupils, allowing the eye care specialist to view the retina for signs of damage or disease.
A dye is injected in the arm and a camera takes pictures of the retina as the dye travels through blood vessels.
Optical coherence tomography
This test uses a special light and a camera to look at cell layers in the retina to see if there is any swelling in the macula.
There are different treatments for DME. More than one treatment may be used, depending on the extent of the DME.
Anti-VEGF injections are considered the standard of care for macular edema, and involve painlessly injecting a medication into the vitreous gel in the eye. The medication in the injection blocks a substance called vascular endothelial growth factor (VEGF) and promotes blood vessel growth. The drugs Avastin, Eylea, and Lucentis are anti-VEGF medications.
Corticosteroid treatments reduce inflammation and are another option for DME. The steroids can be given via eye drops, pills, or injections of sustained-release steroids into the eye.
Laser can be used to seal leaking blood vessels in the retina and slow or stop the growth of new blood vessels that could further damage vision.
In addition to these treatments, it’s important to address the underlying causes of DME: chronic high blood sugars, high blood pressure, high blood fat levels, and kidney disease.
Keep up with regular eye exams that include dilation. If you’re newly diagnosed with type 1 diabetes, get an eye exam within the first five years of diagnosis. If you’ve just been diagnosed with type 2 diabetes, get an eye exam as soon as possible. If you have diabetes and are planning a pregnancy, get your eyes examined before becoming pregnant or in the first trimester if you are pregnant.
If you’ve been diagnosed with diabetic retinopathy, you may need eye exams more often than once a year.
If your blood sugars are consistently running above your target, work with your healthcare team to tweak your diabetes treatment plan. Do the same if your blood pressure and/or blood fat levels are too high. A healthy eating plan, regular physical activity, and weight loss (if you need to lose weight) can help you manage your blood sugars, blood pressure, and blood fats and lower your risk of DME.
Want to learn more about keeping your eyes healthy with diabetes? Read “Eating for Better Vision and Healthy Eyes” and “Keeping Your Eyes Healthy” and “Diabetic Eye Exams: What to Know,” then watch “Diabetes and Your Eyes.”