Diabetic macular edema is the most common complication of diabetic retinopathy. Almost every patient with diabetes will develop some degree of diabetic retinopathy.
Diabetic macular edema (DME) occurs when the normal retinal blood vessels leak into the retina. This “swelling” can cause decreased or blurry vision if the macula is involved. Remember that the macula is the functional center of the retina and provides us with detailed central vision (it is the only part of the retina which can see 20/20).
The goal of your eye doctor is to diagnose diabetic macular edema and treat the swelling before vision is lost. Diagnosis and treatment of diabetic retinopathy is often performed by a retina specialist, such as Dr. Sardi.
Diagnosis of Diabetic Macular Edema
The best way to detect diabetic macular edema is by complete eye examination including direct examination after your pupils have been dilated. Dilated pupils provide your doctor with a direct view of the entire retina and associated structures.
There are characteristic signs of swelling which can be confirmed by OCT (optical coherence tomography) and/or fluorescein angiography. These are ancillary tests which your retina specialist may choose to perform to better study your retina.
Treatment of DME
There are several treatment options;
- Laser photocoagulation
- Anti-VEGF medications
Laser treatment used to be the gold standard for treatment of DME. Using the accuracy of a laser, the leaky retinal blood vessels could be heated at the point of leakage. The laser causes the leaky blood vessels to scar, thus stopping the leakage. Laser photocoagulation, however, can only be used in certain situations, such as when the leakage is not in the center of the macula.
Both steroids and anti-VEGF medications chemically stop the leakage. All may need to be repeated.
Steroid injections around the eye or into the eye is another way to treat DME. Injections of steroids underneath the outside coating of the eye, call the conjunctiva, may be helpful in arresting macular edema. Direct injection of steroids into the vitreous can produce dramatic results.
Two products, Ozurdex and Iluvien, offer sustained release of steroids over months or years inside the eye. These are given as intraocular injections.
Anti-VEGF medications are also given as intraocular injections and include:
These are very similar compounds which chemically stop the leakage. The mechanism by which they work is different than steroids and many times are used in conjunction with steroids.
We look forward to seeing you. If you would like to make an appointment or if you have questions about diabetes, please call us.