Eye Concerns

Diabetes is the most common cause of blindness among working-aged people, and all people living with the disease should monitor their eye health carefully. Over time, diabetes can lead to diabetic retinopathy, which is damage to the blood vessels in the retina. As this damage continues, blood vessels in the retina begin to leak fluid.

This, in turn, can lead to a condition known as diabetic macular edema, or DME, where fluid accumulates in the macula. Patients with DME typically experience blurred vision which may progress to blindness.

• Diabetic Macular Edema (DME) affects up to 10% of all patients with diabetes¹
• Up to 30% of patients with DME will experience moderate visual loss¹

 

 

There are two kinds of DME:

Focal DME is caused by tiny abnormalities in blood vessels, known as microaneurysms. These leaking microaneurysms can lead to vision loss.

Diffuse DME is caused by widening (dilation) of retinal capillaries (extremely thin, narrow blood vessels) throughout the back of the eye.

What are the symptoms?

All patients who suffer from diabetes have a risk of developing DME. The symptoms of DME can include:

• Blurred vision
• Double vision
• Floaters (small black dots or lines made up of cellular debris seen "floating" across the front of the eye) These floaters may temporarily interfere with vision. They are also linked with other eye diseases.

 

What are the causes?

DME is linked with the following:

• The degree of diabetic retinopathy (problems with blood vessels in the retina related to diabetes)
• The length of time a patient has had diabetes
• The type of diabetes each patient has (the milder the diabetes, the lower the incidence of DME)
• Severe hypertension (high blood pressure)
• Fluid retention
• Hypoalbuminemia (low protein in body fluids)
• Hyperlipidemia (high levels of fats in the blood)

 

Many of these conditions can make DME worse, but when they are treated and controlled, DME may get better. 

How is a macular edema treated?

The mainstay of therapy is laser treatment

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed. A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually serveral weeks apart.

Focal laser treatment stabilises vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.

Additionally, there is a new research trialling the use of injected intraocular agents. 

The reality is: even after successful treatment, some people do not experience improved vision. However, if vision remains stable, continued treatment could be beneficial.

Reference:
¹ Ali FA. A review of diabetic macular edema. http://www.djo.harvard.edu/meeei/OA/ME/ME.html. Accessed on the web on 7/26/02, 8:57 am.