Navigating Vision Loss: Coping With Diabetic Macular Edema

Diabetes is a complex condition that affects nearly every part of the body, including the eyes. One of the most challenging eye-related complications is diabetic macular edema (DME), a condition that can lead to vision loss and significantly impact quality of life.

Understanding diabetic macular edema, its effects, and strategies for coping is essential to help patients manage and treat the condition.

Diabetes is a systemic disease where the body does not break down blood sugar correctly. A normal body turns sugars into a molecule called glucose and releases it into the bloodstream.

As blood sugar goes up, the body releases insulin, which allows cells to take in glucose and use it as energy. Patients with diabetes do not produce enough insulin. When the body fails to produce sufficient insulin, glucose stays in the bloodstream.

This can lead to long-term health problems like heart disease, kidney disease, and vision loss.

Diabetic macular edema is a common manifestation of diabetic eye disease (diabetic retinopathy) where fluid builds up in the macula - a small area in the retina responsible for central vision. High blood sugar levels damage blood vessels and produce leaky fluid that swells up in the macula.

If left untreated, this fluid buildup can lead to swelling, distorted vision, and vision loss. Many conditions can cause macular edema, but diabetes is one of the most common.

Anyone with diabetes is at risk for diabetic macular edema. The condition is a leading cause of vision impairment among diabetics, particularly those who have had diabetes for many years.

Other factors that put patients at risk for diabetic macular edema include:

• Poor blood sugar control

• High blood pressure

• High cholesterol levels

• Prolonged duration of diabetes

• Smoking

Diabetic patients should be extra cautious as diabetic macular edema often develops slowly, with early symptoms going unnoticed.

As the condition progresses and becomes more severe, patients may experience:

• Blurred or wavy central vision

• Difficulty reading or recognizing faces

• Colors appearing faded or washed out

• An uptick in eye floaters (spots in a patient's visual field that look like black or gray specks).

If a patient has diabetes, and notices diabetic macular edema symptoms, they should promptly contact their eye doctor.

If a patient shows diabetic macular edema symptoms their doctor will typically conduct a comprehensive eye exam. During the exam the doctor may conduct the following tests:

Visual acuity test: To measure a patient’s vision at a variety of distances.

Eye dilation: Allows the doctor to have a better look at the retina to check for signs of damage or swelling.

Optical coherence tomography (OCT): Gives doctors a detailed image of a patient’s retina, and highlights areas of swelling or fluid buildup.

Fluorescein angiography: A special dye is injected into the bloodstream to identify leaking blood vessels in the retina.

Treatment options for diabetic macular edema vary depending on a patient’s visual acuity and the severity of the disease. Most treatment options focus on reducing swelling, stopping fluid leakage, and preserving or restoring vision. Common treatments include:

These are injections administered directly into a patient’s eye to reduce swelling. They include medications such as:

• Aflibercept

• Bevacizumab

• Faricimab-svoa

• Ranibizumab

• Dexamethasone

In 40% of chronic DME cases, anti-VEGF therapy is not sufficient. In these cases, doctors may use corticosteroid therapy to reduce swelling and inflammation in the retina.

Treatment can be administered through a single intravitreal injection or through a series of sustained-release intravitreal implants that provide ongoing medication over months.

While this is less common, in certain cases doctors may use a laser to seal leaking blood vessels and reduce fluid buildup in the retina.

In severe cases, patients can also receive a surgery (a vitrectomy) to remove blood or scar tissue from the retina.

Diabetic patients can take steps to prevent diabetic macular edema, or at least minimize the impact it has on their health and vision.

Maintaining stable blood sugar levels is essential to manage diabetic macular edema as well as other health complications. Diabetic patients will typically work with their health care professionals for a personalized plan.

Most attempts to control blood sugar will include:

• Changing a diet to one rich in vegetables, grains, lean proteins, and healthy fats.

• Getting regular exercise and physical activity.

• Managing diabetes through prescribed insulin and oral medication.

It is recommended that patients schedule a comprehensive eye exam at least once a year. This is especially important for patients with diabetes to detect diabetic retinopathy and prevent a progression towards diabetic macular edema.

If patients have been diagnosed with diabetic macular edema, they should take extra precautions to monitor their health. To minimize side effects they should contact their doctor if they experience symptoms such as:

• Sudden deterioration in vision or vision loss

• Persistent floaters in the eyes

• Painful red eyes

• Difficulty seeing in the dark

High blood pressure and cholesterol can make diabetic eye disease worse. Patients should follow the doctor’s instructions to control their blood pressure. Common suggestions patients may receive from their doctor:

Lose weight: If overweight, weight loss is one of the most reliable ways to control blood pressure and cholesterol.

Limit alcohol: Alcohol can raise a patient's blood pressure. Patients should make an effort to reduce their drinking.

Exercise: Even moderate amounts of exercise can lower pressure.

Reduce stress: Stress hormones can cause short term spikes in blood pressure. Stress can also lead to bad habits that affect blood pressure such as alcohol use and sleep deprivation.

Smoking damages blood vessels and increases the risk of diabetic complications, including eye diseases. If patients are occasional smokers, they should avoid tobacco products and locations such as bars where smoking may take place.

If patients are habitual smokers, they should take steps to quit. While quitting smoking is not easy, patients can take steps such as replacing cigarettes with alternatives like patches or lozenges.

In more serious cases doctors may recommend medications, injections, or laser therapy to manage diabetic eye conditions. To avoid serious side effects, patients should follow the course of treatment their doctor suggests.