Diabetic Macular Edema (DME)

DME is an eye condition which can occur in people living with diabetes - both type 1 and type 2. Consistently high blood sugar due to poor glucose control over time can damage small blood vessels in the body, including the eye. Diabetic retinopathy is a disease that damages the blood vessels in the retina, resulting in vision impairment. Left untreated, fluid can leak into the center of the macula, called the fovea, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called DME. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses.

People who have diabetes are at risk of developing DME over time. A person with diabetes should have their vision checked yearly, or as directed by their eye doctor. Vision changes due to DME are:

• Blurred vision
• Double vision
• Sudden increase in eye floaters

Increased risk of DME is associated with:

• Poor glucose control over a long period of time
• Increased length of time living with diabetes- The lifetime risk of developing DME for people with diabetes is about 10%.
• Type of diabetes - After living with diabetes for 20 years, nearly all with type 1 and 60% with type 2 diabetes will have some diabetic retinopathy. It usually does not affect vision in the early stages.
• Very high blood pressure
• Fluid retention
• Kidney disease
• High fat levels in the blood (hyperlipidemia)
• Pregnancy – Women who develop diabetes during pregnancy are at risk for diabetic retinopathy and DME.

• Maintaining good blood sugar, blood pressure, and cholesterol control helps prevent DME.
• Receiving a comprehensive dilated eye exam at least once a year, or more often as directed by the eye doctor.
• Pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. The eye doctor may recommend additional exams during pregnancy.
• Maintaining a healthy lifestyle, exercising regularly, and having a healthy diet. Talk to a doctor before starting an exercise program.

People living with diabetes are advised to have a comprehensive dilated eye exam at least once a year, or more often as directed by the eye doctor. If blurred vision occurs, the patient should visit an eye doctor immediately. At the visit, the eye doctor will conduct the following tests.

• Visual acuity: This will determine how well a person can see through his or her central vision and if there is a decrease in visual acuity.
• Dilation: The eye doctor will dilate, widen the pupil of the eye, with eye drops to allow a closer look at the inside of the eye.

If the eye doctor suspects DME, then the following tests may be conducted:

• Optical coherence tomography (OCT): The OCT examination provides a cross sectional image of the eye which can show if the macula is thickened or if fluid is leaking.
• Fluorescein angiography: During this test, a dye is injected into the arm that “lights up” the blood vessels in the eye while multiple photos are taken of the back of the eye. These images will show if there are new blood vessels in macula and /or there is leaking of dye to determine if an individual has DME.