What is Diabetic Macular Edema (DME)?
Dr. H Janhavi
Kalyan nagar, Bengaluru Jan 22, 2018
Macular oedema or edema is the retinal edema that builds up of fluid in the centre of the macula, in the retina. The retina, at the back of the eye, is a light-sensitive tissue, and the macula is the part of the retina producing a clear, straight-ahead image of any structure.
Macular oedema occurs when there are unusual or irregular leakage and build-up of fluid in the macula from marred blood vessels in the nearby retina. The fluid that has been accumulated makes the macula to bulge and widen (retina swelling), which deteriorates vision. When this happens, the oedema fluid typically combines in multiple cyst-like patterns which are called cystoid macular oedema, causing retina swelling.
A usual cause of macular oedema is proliferative Diabetic Retinopathy, a disorder that can appear in people with diabetes. Macular oedema can also develop after eye surgery, as a consequence of age-related macular degeneration or inflammatory conditions that affect the eye. Any infirmity that impairs blood vessels in the retina can induce macular oedema.
Diabetic Macular Edema
Due to leakage of blood vessels, fluid accumulates in the part of the retina called the macula, which is responsible for the ability of detailed vision. If left untreated, the building pressure in the eye results in fluid leakage causing DME, i.e. Diabetic Macular Edema.
Diabetic Macular Edema develops only among those who have Diabetic Retinopathy condition, which causes blood vessel damage. High blood sugar control and supplementary medical conditions, such as high blood pressure, raise the uncertainty of blindness for people with DME. It can develop at any stage of diabetic retinopathy, although it is more disposed to occur later as the disease advances to grow.
This conditions can be of two types-
Focal DME: which occurs due to blood vessel abnormalities
Diffuse DME: which arises due to thin blood vessels and swelling of retinal capillaries
CSME eye or Clinically Significant Macular Edema (CSME)
Diabetic Macular Edema is most typically categorised into either being clinically significant or not. Clinically Significant Macular Edema (CSME) is described as a DME if matching at least one of the criteria presented as follows.
Guidelines for the Diagnosis of CSME
Thickening of the retina at or within 500 μm or 1/3 disc diameter of the centre of the macula
Thick exudates at or within 500 μm of the centre of the macula, associated with adjacent retina thickening
Any area(s) of retinal thickness larger than 1 disc area, any part of which is within 1 disc diameter of the centre of the macula
DME may also be categorised based on OCT or Optical Coherence Tomography measurements and dimensions, specially, the thickness of the macula, morphology of the retina, and the possession of macular traction.
Common Factors and Symptoms of Diabetic Macular Edema
You may observe Diabetic Retinopathy (DR) or other eye dilemmas associated with diabetes by factors and signs such as:
Eye floaters and spots or Fluctuating vision
Development of a or shadow in your field of view
Eye discomfort or pain
Deposits of bleeding or leakage of fluids from blood vessels.
Near vision problems irrelevant to presbyopia
Sometimes, one of the symptoms of diabetic eye disease, i.e. nerve damage (neuropathy) is overlooked, which affects ocular muscles that control eye movements. These signs can incorporate instinctive eye movement (nystagmus) and double vision.
Diagnosis for Diabetic Macular Edema
For the diagnosis, your eye doctor will examine for signs of any Diabetic Retinopathy or Diabetic Macular Edema, during an eye check-up.
The eye specialist will use a special camera or another imaging device to photograph the retina and study for revealing signs of diabetes-related impairment. In a few cases, he or she may suggest you visit a retinal specialist for additional testing and probable treatment.
For a more definitive diagnosis, you may be asked to undergo a test called fluorescein angiography. During this test, a dye is introduced into your arm intravenously and progressively emerges in the blood vessels of the retina, where it is illuminated to detect diabetes-related blood vessel modifications and any blood leakage in the retina.
Treatment for Diabetic Macular Edema
These treatments of DME usually targets the marred eye tissue. Some lasers aim at sealing the leakages and heals the swelling around the macula (photocoagulation). Other lasers eliminate unusual blood vessels of retinal veins that form from neovascularisation.
Focal or grid laser photocoagulation- This procedure targets directly at the affected area or implemented in a grid-like pattern to destroy injured eye tissue and clean away defects that add to blind spots and vision loss.
Panretinal laser photocoagulation (PRP)- With the help of this method, approximately thousand to two thousand tiny spots of laser energy are implemented to the edge of the retina, leaving the central area unharmed.
Sometimes an injection of corticosteroids or other medications into the eye is recommended. It can be introduced either directly or in the form of an injectable implant. In a few cases, an aggregation of drug injections and laser treatment may be recommended.
FDA-approved Anti-VEGF (vascular endothelial growth factor) drugs or drug-releasing implants for injecting into the eye for DME treatment include:
Vitrectomy and other surgical treatments
Laser photocoagulation treatment becomes impossible due to the bleeding into the vitreous (vitreous haemorrhage) in some cases. It is because the blood obscures the surgeon’s view of the retina.
If the vitreous haemorrhage fails to clear within a few weeks or months, a surgical procedure called a vitrectomy might be performed to remove the bloody vitreous and replace it with a transparent gel-like material.
Procedure Recovery of Diabetic Macular Edema
Standard restoration time after a DME treatment is nearly 3-6 months. As the eye recovers and the swelling in and around the macula falls, you may encounter sensitivity to light, irritability in the eye, and black spots in the centre of your eyesight. These are common side effects, and will gradually disappear with time. Sadly, laser surgery does not always render enhanced vision to those with DME.
Prevention of Diabetic Macular Edema
Sometimes, you can’t do anything to prevent Diabetic Retinopathy or DME. Still, your best possibility of evading them comes by sustaining a healthy lifestyle, exercising regularly, having lots of vegetables and fruit in the diet regimen, and visiting your eye specialist at least once a year to intensify your eye health.
Controlling blood sugar levels, cholesterol levels and blood pressure help in preventing DME.
Maintaining a healthy lifestyle, healthy diet and regular exercise before starting an exercise program is required.
Obtaining a complete eye checkup at least once a year, or more is also essential.
Pregnant woman with diabetes should have a thorough dilated eye checkup as early as possible.
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