Diabetic Macular Edema (DME)

Diabetic macular edema (DME)

Diabetic macular edema (DME) is a common complication of diabetes that affects the central part of the retina called the macula. Macular edema is swelling of the macula, the area of the retina responsible for central vision.¹

The incidence and prevalence of DME varies depending on the type of diabetes (type 1 or type 2), and the duration of the disease (years since diagnosis). Typically, 27% of people with type 1 diabetes develop DME within 9 years of diabetes diagnosis; and 28% with type 2 diabetes present the disease after 20 years.²

What causes Diabetic Macular Edema?

Uncontrolled diabetes generates an inflammatory cascade that leads to DME; hyperglycemia causes inflammation and chronic hyperglycemia causes oxidative stress, which initiates a local inflammatory cascade, resulting in vascular abnormalities, edema, and thickening of the retina.³

What are the symptoms of Diabetic Macular Edema?

The main symptom that patients with DME present is visual deficiency, manifested by reduced central vision, which can be observed through stereoscopic examination or inferred by the presence of intraretinal exudates. Hyperglycemia, hypertension, and hyperlipidemia are recognized as important risk factors for both the development and progression of DME. Therefore, in patients with DME, attempts should be made to normalize hyperglycemia, lipid levels, and blood pressure, as well as improve renal status.The primary symptoms patients experience are loss of central vision or blurred vision. These occur when the accumulation of fluids affects the central area of the retina, the ocular macula, which is also responsible for detailed vision, color perception, and movement detection. Lesions in the macula of the eye in patients with DME cause a progressive loss of visual acuity over time that can culminate in irreversible blindness. This is because the damage to vision is progressive and cannot be corrected.³

References:

1. Browning DJ, Stewart MW, Lee C. Diabetic macular edema: Evidence-based management. Indian J Ophthalmol. 2018 Dec;66(12):1736-1750. doi: 10.4103/ijo.IJO_1240_18. PMID: 30451174; PMCID: PMC6256891.

2. Romero-Aroca P. Managing diabetic macular edema: The leading cause of diabetes blindness. World J Diabetes. 2011 Jun 15;2(6):98-104. doi: 10.4239/wjd.v2.i6.98. PMID: 21860693; PMCID: PMC3158878.

3. Das A, et al. Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology. 2015;122(7):1375-94