Diabetic Macular Edema

DME is one of the leading causes of vision loss among people with diabetes. Early diagnosis and timely treatment can reduce the risk of long-term vision loss.

DME is characterized by damage to the blood vessels in the retina (the light-sensitive inner layer of the eye). This damage causes fluid leakage into the eye and leads to swelling in the macula, the central part of the retina. As a result, blurred vision and vision loss may develop.

Two proteins contribute to macular swelling: VEGF and Ang-2. These proteins promote the formation of abnormal and fragile blood vessels. These vessels can leak fluid, which may lead to vision loss in patients with DME.

Signs and Symptoms

The following symptoms may occur:

• Seeing black lines or spots in the visual field (floaters)

• Colors appearing faded

• Blurred or wavy vision

• Changes in the size or shape of objects

• Difficulty seeing in bright light or reflections

• Difficulty reading or driving

Diagnosis

People with diabetes are at risk of developing DME. If not diagnosed and treated in time with effective therapy, the disease may progress and lead to vision loss. Therefore, individuals in the risk group are advised to have regular eye examinations at least once a year to allow early treatment and reduce the risk of vision loss.

The diagnosis of DME is made through a comprehensive eye examination and various imaging tests. The main steps in the diagnostic process include:

• Eye Examination and Visual Acuity Test: Visual acuity is assessed and intraocular pressure is measured. The pupil is dilated so that the retina and macula can be examined in detail.

• Optical Coherence Tomography (OCT): Provides cross-sectional images of the retina to determine the presence and severity of macular edema. OCT is considered the gold standard for diagnosing DME.

• Fluorescein Angiography (FFA): Evaluates retinal blood vessels and identifies areas of fluid leakage. This test is particularly useful for detecting vascular occlusions and abnormal blood vessel formation.

These tests are used together to confirm the diagnosis of DME and guide treatment planning. Early diagnosis is critical to prevent vision loss.

Treatment

Until about a decade ago, the main treatment for retinal diseases, including diabetic macular edema (DME), was laser therapy. This method helped slow disease progression but did not significantly improve vision.

Later, intravitreal injections that inhibit VEGF (anti-VEGF therapy) were developed. These treatments primarily work through the anti-VEGF pathway, reducing abnormal blood vessel formation in the retina and thereby helping improve vision.

In addition to anti-VEGF therapies, a treatment option targeting the two main mechanisms of the disease simultaneously (anti-VEGF/anti-Ang-2) has also been developed.

To achieve the best treatment outcomes in patients with DME, the following practices are recommended:

• Reducing risk factors by controlling blood sugar, blood pressure, and cholesterol levels; quitting smoking if applicable; and maintaining regular physical activity

• Continuing treatment without interruption and attending all scheduled medical appointments regularly