Unlocking Vision: Understanding Everything About Diabetic Macular Edema

What is DME?

DME stands for Diabetic Macular Edema, a medical condition affecting the eye in individuals with diabetes. DME is a common medical abbreviation for Diabetic Macular Edema. 

DME primarily affects the eye, specifically the macula, leading to vision problems and visual disturbances. It happens when fluid accumulates in the central part of the retina (eye), causing blurry vision. Treatment options are available to manage this condition and maintain vision.

Symptoms of Diabetic Macular Edema

Common symptoms of diabetic macular edema include:

• Blurred vision: A typical symptom of diabetic macular edema is blurry vision, which can affect the ability to see fine details.
• Distorted vision: Straight lines may appear wavy or bent, making reading or recognising objects difficult.
• Colour changes: Colors may appear faded or washed out.
• Dark spots: Dark spots or empty spaces may appear in the central vision, obstructing clear sight.

Learn more: Ways to Improve your Eyesight

Causes of Diabetic Macular edema

Various causes of diabetic macular edema include:

• High blood sugar levels: When diabetes is not managed correctly, it can damage the blood vessels in the retina. This damage can cause fluid to leak into the macula.
• Prolonged diabetes duration: Individuals with long-standing diabetes are likely to develop diabetic macular edema.
• Poor diabetes management: Inadequate blood sugar levels, blood pressure, and cholesterol control can increase the likelihood of macular edema in diabetics.

Types of Diabetic Macular Edema

Most typical types of DME include

Early diabetic macular edema

It is the initial stage of diabetic macular edema, where mild swelling and fluid buildup occur in the macula (a small, specialised area near the retina’s central region, the light-sensitive tissue in the eye). It may not cause noticeable vision problems initially, but early detection and management are essential to prevent progression.

Simple diabetic macular Edema

The macula has moderate swelling in this type, leading to blurred or distorted vision. It may affect both eyes and can worsen over time if left untreated. Regular monitoring and proper management of diabetes are crucial for controlling this type.

Cystoid diabetic macular edema

Cystoid diabetic macular edema is characterised by the formation of fluid-filled cysts in the macula, causing significant vision loss. It can result in distorted or blurry central vision. Fast diagnosis and treatment are essential to prevent further damage and preserve vision.

The Risk Factors for Diabetic Macular Edema

• Poor blood sugar management: Inadequate control of blood sugar levels increases the risk of developing DME.
• High cholesterol: Elevated cholesterol levels can contribute to the development of DME in individuals with diabetes.
• High blood pressure: Unchecked high blood pressure is a risk factor for DME.
• Kidney disease (nephropathy): Individuals with kidney disease associated with diabetes have a heightened risk of developing DME.

Learn more: How to Improve your Kidney Health

Diagnosing Diabetic Macular edema

At Home

It is impossible to diagnose DME at home. If you are experiencing signs or are at risk, seeing an eye specialist for a proper diagnosis is essential.

Learn more: Home remedies for Eye Infection

Eye Exams

Eye exams are essential for diagnosing DME. An eye specialist will examine your eyes using various tests and tools to determine if you have DME and assess the severity.

Tests for DME

Tests used to diagnose DME may include optical coherence tomography (OCT), which creates detailed retina images, and fluorescein angiography, which involves injecting a dye into your arm to highlight blood vessels in the eye and detect abnormalities. These tests help the eye specialist make an accurate diagnosis and determine the appropriate treatment.

How to Prevent DME

Strategies for the prevention of the DME includes

• Discuss treatment options with your doctor: It’s always possible to start treatment for DME. Acting quickly can prevent long-term eye damage.
• Schedule annual eye checkups: Regular doctor visits can help detect changes in your vision and ensure timely intervention.
• Act on vision changes promptly: If you notice any changes, contact your eye care doctor immediately for evaluation and guidance.
• Manage blood sugar levels: Work closely with your doctor to effectively control your blood sugar levels, which can help prevent complications.

Learn more: Eye Care Tips

Diabetic macular edema treatments

Various treatments that help manage DME include

1) Laser photocoagulation

This treatment uses a laser to seal leaking blood vessels in the retina, reducing swelling and preventing further vision loss. It is commonly used for focal macular edema.

2) Corticosteroids

Corticosteroids can be injected into the eye to decrease inflammation and reduce macular edema. They help to control the swelling and improve vision, but their effects may be temporary.

3) Anti-VEGF therapy

Injections of anti-VEGF drugs block the growth of abnormal blood vessels and reduce fluid leakage in the macula. This treatment has shown promising results in improving vision and preventing further damage in patients with diabetic macular edema. 

4) mTOR inhibitors

mTOR inhibitors are a class of medications that can treat diabetic macular edema by inhibiting specific cell signalling pathways involved in abnormal blood vessel growth and inflammation in the retina. They have shown potential in reducing macular edema and improving visual acuity.

5) Protein kinase C

Inhibition of protein kinase C, an enzyme involved in various cellular processes, has been investigated as a potential treatment for diabetic macular edema. Targeting this enzyme is hoped to reduce inflammation and prevent blood vessel leakage in the retina.

6) Ras/Raf/Mek/Erk

This signalling pathway plays a role in the development of diabetic macular edema. Inhibitors targeting specific components of this pathway are being studied as potential treatments to suppress abnormal blood vessel growth and decrease retinal inflammation.

7) ICAM-1

ICAM-1 is a cell adhesion molecule involved in the inflammatory process. Targeting ICAM-1 may help reduce the adhesion of inflammatory cells in the retina and alleviate macular edema.

8) MMPs

Matrix metalloproteinases (MMPs) are enzymes that contribute to the breakdown of the matrix in the retina. Inhibiting MMPs may help reduce the breakdown of the blood-retinal barrier and prevent fluid accumulation in the macula.

9) Nicotinic acetylcholine receptor

Activation of nicotinic acetylcholine receptors has shown potential in reducing inflammation and preventing blood vessel leakage in diabetic macular edema. Modulating these receptors may help in improving macular edema and preserving vision.

10) Receptor for Advanced Glycation End-Products

Inhibition of the receptor for advanced glycation end-products (RAGE) has been studied as a potential therapeutic target for diabetic macular edema. By blocking RAGE, it is hypothesised to reduce inflammation and vascular leakage in the retina.

11) Renin-angiotensin system

Medications that target the renin-angiotensin system, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), are commonly used to manage conditions like high blood pressure. It can also affect diabetic macular edema by reducing inflammation and improving blood flow in the retina.

12) Combined Therapies

Different treatments may sometimes be used to manage diabetic macular edema. This approach may involve a combination of laser photocoagulation, anti-VEGF therapy, corticosteroids, or other targeted therapies to achieve better outcomes in reducing macular edema and improving vision.

Conclusion

Diabetic macular edema (DME) can be managed with various treatments. It is possible to maintain or even regain vision. Detecting DME early can help prevent vision loss. Regular visits to your eye care doctor are crucial for eye health and overall well-being.

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Disclaimer 

The content provided within this article has been thoroughly verified for accuracy. However, we advise consulting a healthcare professional before utilising any medication or dietary supplements mentioned herein.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277023/ 
• https://www.hindawi.com/journals/jdr/2015/794036/ 
• https://eyewiki.aao.org/Diabetic_Macular_Edema 
• https://www.sciencedirect.com/science/article/pii/S0039625708001811 
• https://cellandbioscience.biomedcentral.com/articles/10.1186/2045-3701-4-27#Sec24