Diabetic macular edema (DME) is a complication of diabetic retinopathy, an eye disease related to diabetes.
DME affects an estimated 750,000 people in the United States, according to the National Eye Institute. The condition is the leading cause of blindness among people with diabetic retinopathy.
There’s no cure for DME, but treatment can stop or slow its progression. Read on to learn more about DME, treatment options and goals, and the steps you can take to protect your vision.
What is diabetic macular edema?
DME is a complication of diabetic retinopathy that can lead to vision loss and blindness.
Diabetic retinopathy is a common diabetes-related eye disease. It’s estimated to affect about 1 in 3 people with diabetes over the age of 40, per the National Institute of Diabetes and Digestive and Kidney Diseases.
Diabetic retinopathy happens when chronically high blood sugar levels damage the small blood vessels throughout your body, including your eyes.
Once they’re damaged, blood vessels can start leaking blood and other fluids. A part of your eye called the retina can absorb some excess fluid. But when there’s too much fluid, you can experience swelling and thickening of the macula, an area in the center of the retina that helps you see clearly and precisely.
You may not notice any signs of DME at first. But over time, DME can cause symptoms like:
- blurry or wavy vision near the center of your field of vision
- double vision
- faded, less vibrant colors
- floaters and blind spots
- partial or total vision loss
The longer you live with diabetes, the more likely you are to develop diabetic retinopathy or DME.
Can diabetic macular edema be cured?
There’s no cure for DME, but scientists are looking for potential ways to reverse vision damage from the condition, or prevent it from occurring.
The National Eye Institute reports that researchers are studying whether micro- RNAs, or molecules that regulate certain genes, can help shut down genes related to the development of macular edema. Yet more research is needed.
In the meantime, DME treatments and diabetes management strategies can help stop or slow the progression of the disease.
The goal of treatment is to prevent further vision loss or blindness. In some cases, treatment can lead to vision improvements for people with DME, but it usually doesn’t fully restore sight.
If DME hasn’t made a noticeable impact on your vision, you may not need treatment right away.
However, your eye doctor will likely want to keep a close eye on potential signs that the condition is worsening, so you may need to get frequent vision check- ups.
Treatment typically starts once your vision worsens, to prevent permanent damage.
Your DME treatment options depend on the severity of your vision loss. Sometimes, an ophthalmologist will recommend a combination of therapies.
Here are the treatment options for DME:
The main treatment for DME is anti-VEGF injections into the eye.
These injections stop the activity of vascular endothelial growth factor (VEGF) to promote the growth of blood vessels. This can reduce leakage from damaged blood vessels and slow the progression of DME.
Anti-VEGF drugs include:
- aflibercept (Eylea)
- bevacizumab (Avastin)
- ranibizumab (Lucentis)
Anti-VEGF therapy is usually a quick procedure that takes place in the doctor’s office. Numbing drops will prevent you from feeling the needle. You may need to get a series of anti-VEGF injections over time to maintain your vision.
Unfortunately, anti-VEGF injections don’t work for everyone. Around half of the people who try this treatment don’t see improvements, according to the National Eye Institute.
Corticosteroids can also help treat DME by reducing inflammation and swelling. They come in the form of drops, tablets, or injections in or around the eye.
There are also three sustained-release corticosteroid implants approved to treat DME:
- dexamethasone (Ozurdex)
- fluocinolone (Retisert)
- fluocinolone acetonide (Iluvien)
When corticosteroids don’t work or aren’t well tolerated, your doctor may recommend trying eye drops of nonsteroidal anti-inflammatory drugs (NSAIDs).
Laser therapy uses tiny laser pulses to seal off leaky blood vessels. This can also keep new abnormal blood vessels from growing.
Laser therapy can be performed in a doctor’s office. Anesthetic eye drops make it a painless procedure. A doctor will use special instruments to hold your eye open and keep your head from moving while they focus the beam of light to the damaged areas.
If you have macular edema in both eyes, they will likely be treated in separate appointments. Each eye may require several laser therapy appointments, depending on the extent of the damage to the macula.
Laser therapy can lower the risk of vision loss due to DME.
It’s important to note that while laser therapy used to be the standard therapy for DME, most doctors are now relying on anti-VEGF injections instead.
In advanced cases of DME, surgery may be a treatment option. It involves a procedure called vitrectomy to remove a gel-like substance known as vitreous that fills the inside of the eye and can pull on the macula.
Once the surgeon removes the vitreous, they will replace it with another substance, such as a saline solution.
Keep in mind that vitrectomy may raise the risk of cataracts and you can develop DME again after surgery.
Other ways to slow or reverse progression of diabetic macular edema
Understanding the risk factors for DME can help you take steps to prevent it. These include:
- high blood sugar over a long period of time
- high levels of fat in the blood (hyperlipidemia)
- high blood pressure
Keeping a close eye on these conditions and taking steps to manage your diabetes can help improve your symptoms and eye health. Other ways to help manage diabetes include:
- see your endocrinologist as recommended
- take medications as advised
- get a comprehensive eye screening every year (or more frequently if your doctor recommends it)
- report new or worsening symptoms to your doctor
- maintain a moderate weight for your body type and size, as recommended by your doctor or healthcare professional
- eat a healthy, balanced diet
- get regular physical activity
- avoid or limit alcohol consumption
- quit smoking
DME is a complication of diabetic retinopathy caused by long-term damage to blood vessels in the retina.
There’s no cure, but DME can be managed. There are several treatments that can help slow the progression of the condition and prevent partial or complete vision loss.
Scientists are looking into the possibility of curing or preventing DME with micro-RNAs, but more research is needed.
If you notice signs of DME, such as blurry or wavy vision or colors that look less vibrant than usual, speak with an eye care professional right away.
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