Although diabetic eye diseases, including DME, can eventually cause irreversible blindness, according to the National Eye Institute (NEI), there are steps you can take to treat this common complication of diabetes early to 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 — which causes swelling. The primary risk factor for diabetic retinopathy and 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 about 37 million Americans have diabetes, according to the Centers for Disease Control and Prevention, vision loss associated with the condition may affect nearly 4 million people in the U.S. 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 your central field of vision could eventually 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, how well 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 average measure of your blood sugar over a three-month period. Lowering your A1C can help slow the advancement of DME and protect your vision, says Casper. Until relatively recently, says Casper, the only treatment option was laser treatments, which seal off capillaries to stop leakage. Now, eye injections that stymie blood vessel growth and leakage are available. Your doctor may recommend corticosteroid injections, which are used to reduce inflammation in the eye to stop leakage, or drugs that are designed to block the accumulation of vascular endothelial growth factor (VEGF), a protein that produces new blood vessels in the eye. By blocking VEGF, these drugs 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. A surgeon may also implant a small capsule in your eye that is designed to slowly release medication over a long period, preventing the need for multiple injections. A Cochrane Library review published in October 2018 found that anti-VEGF treatment can be effective for people with DME. A more recent study, published in December 2020 in the journal Scientific Reports, noted that not only did this type of treatment reduce macular swelling and improve vision, but researchers were also able to get these results even when extending the time between injections, meaning people needed fewer injections as time went on. If you also take metformin to treat diabetes, research published in April 2022 in the journal Acta Diabetologica suggests that this medication can help make the anti-VEGF injections more effective. 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 usually stop the progression of the disease, but if DME-related vision loss has occurred, improvement may be limited, and complete recovery of vision is not common,” Casper explains.
