Diabetes is a global concerning condition that affects a large number of the population. There are two types of diabetes.
These include type 1 and type 2 diabetes. Type 2 diabetes is more common. This is also considered a preventable type of diabetes. The scientific classification for the condition is diabetes mellitus1.
The prevalence of diabetes has also increased significantly over the years. By 1980, an estimated 4.7% of the global population were affected by diabetes. In 2014, this number increased to 8.5% of the worldwide population2.
Numerous complications of diabetes are linked to this metabolic condition. It causes problems with the cardiovascular system.
It also leads to neuropathy. This affects nerves and kidneys. Another critical complication lies with the eyes. Retinopathy is common. Patients should also be aware of diabetic macular edema.
We take a look at what diabetic macular edema is. This post will also consider possible causes for this condition. Both central and branch retinal vein occlusion is frequently related to macular edema.
We look at the symptoms that patients should look out for. We will analyze the research and clinical trials that focus on the condition. Furthermore, we consider both treatment and prevention strategies.
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What Is Diabetic Macular Edema?
Diabetic macular edema is a complication that can occur in people who have been diagnosed with diabetes. In one report, it is estimated that an estimated 3.8% of the American population has signs of this condition3.
Edema generally refers to an accumulation of fluid at some part of the body. In many people with heart disease, for example, edema will occur within their feet. This means there will be swelling of the feet.
In people with Diabetic Macular Edema, the accumulation of fluid occurs in the patient’s eye. More specifically, the fluid will accumulate in the patient’s macula. This is the central region of the eye’s retina.
The retina itself is made up of tissue that is very sensitive to light. It is situated at the back of the eye. The macula itself helps to retina create sharper vision. The fovea, the small pit located in the macula, is responsible for the clearest vision. Straight-ahead vision is another factor that the macula is needed for in the retina.
When a patient with diabetes develops macular edema, problems can occur. The fluid that accumulates causes the macula itself to become thicker and swell up. When the macula swells up, it causes distortions in the patient’s vision. Laser photocoagulation can help reduce the visible macular edema in diabetic patients.
Causes
Diabetic macular edema is linked to diabetes. While this may seem obvious, it is also important to realize the mechanisms behind the disease. Understanding why the condition occurs is important. This helps a person know what to look out for.
An abnormal leakage is generally the cause behind macular edema. When leakage occurs, there is a fluid that will accumulate in the macula. The fluid generally comes from blood vessels that have been damaged. These blood vessels are typically located close to the retina.
Diabetic retinopathy is considered the most common cause of macular edema. Diabetic retinopathy is a disease linked to diabetes. It is important to note that macular edema is not always related to diabetes, however.
There are cases where surgery to the eye may lead to macular edema too. This is generally the case when surgery is done for age-related macular degeneration. Surgery may also be used for other inflammatory conditions that affect the patient’s eye capillaries.
Furthermore, conditions that cause damage to blood vessels that are found in the patient’s retina may also contribute to the disease.
These are the general conditions and factors that may contribute to macular edema. If a patient is diagnosed with diabetic macular edema, it means the cause would be diabetic retinopathy. In this case, nerves in the eye may be damaged. This would account for damage alongside the blood vessels in the area of the blood vessels.
Complications during plana vitrectomy can occur, which include holes in the retinal area, fragmentation or migration of the parasite, and more.
Vitrectomy is a surgical procedure that repairs multiple issues in the eye, from removing scars to treating macular holes and repairing retinal detachments.
Symptoms
Patients need to realize the symptoms of diabetic macular edema early on. When the condition is diagnosed early on, management becomes easier. A later-stage diagnosis can make it harder for an eye doctor to effectively manages the condition.
All patients with diabetes should take notice when there is any type of change with their vision that includes intraocular pressure or pressure in the eyes. This is because several conditions can affect the eyes of a patient with diabetes.
The main symptom that a patient may experience is blurry vision. Sometimes, a person may report a wavy vision instead. This blurriness would develop at the center of the person’s visual field. The reason for the blurred vision is the swelling in the macula.
There are some cases where colors may also appear faded out. Some people would report this as colors being washed out.
During the early stages of diabetic macular edema, the blurry vision will likely be mild. As the condition progress, however, the field of vision affected by the blurriness can expand. The slightly blurry vision becomes more of a significant problem down the line.
Eventually, a person may find that they suffer a noticeable level of vision loss, often characterized by the retinal thickness.
There are many cases where only one eye will be affected by the condition. In such a case, it is often difficult for the patient to recognize the blurry vision during an early stage. As the disease progress, however, the blurriness and loss of vision become more prominent.
Complications
The leakage that occurs in the retina causes the macula to become swollen. The leaking and swelling in the back of the eye are the most prevalent causes of retinal detachment.
The swelling can eventually lead to long-term damage to the area. It is also important to notice here that the cause behind this is generally leakage of blood vessels. These blood vessels have been damaged. The damage tends to become worse over time.
For most people, complications associated with diabetic macular edema means experiencing blurry vision. There are, however, cases where a person may lose a significant amount of their sight.
These complications are mostly found among individuals who do not receive appropriate treatment early on. There are some treatments that may assist in reducing the risk of serious complications. In some cases, these treatments can at least slow down the progression of the disease.
Who’s At Risk?
By understanding who is at risk, it becomes easier for a person to know how likely they are to develop the condition. For this reason, every person should assess their own risk factors.
Diabetes is the leading risk factor for this disease. It should be noted that this accounts for diabetic macular edema mainly. Any person with diabetes may develop diabetic macular edema.
At the same time, it is important to realize that the condition is more commonly found among those with complications due to uncontrolled diabetes.
If the patient develops diabetic retinopathy, then their risk of macular edema would increase, of course. Diabetic retinopathy is known to cause a leakage that may ultimately contribute to the development of macular edema.
How Is It Diagnosed?
A diagnosis of diabetic macular edema is essential. The earlier the condition is identified in a patient, the better the chances that it can be managed more effectively.
For this reason, individuals with diabetes should be made aware of the symptoms.
Each eye should be regularly checked for blurry spots. In case any type of blurry or wavy spots are recognized, a consultation with an eye care professional should be arranged.
The diagnosis of diabetic macular edema involves a couple of steps.
The first step is for a standard comprehensive eye examination. This is the normal eye examination that anyone goes through when they visit an optometrist.
The examination allows the professional to determine the sigh of the patient. It also helps the eye care specialist detect any abnormalities with the macula or the retina of the patient.
Several other optical coherence tomography oct tests may also be ordered to assist in the diagnosis of the condition.
Other tests may include:
- Visual acuity test: This is a visual test. It helps to identify a patient’s vision loss. It can diagnose vision loss caused by macular edema4. A card with letter rows is used in the test. At the top, the letters will be large. The letter size is reduced toward the bottom of the card. The patient’s eye will be covered during the test. They will be asked to read all the letters they can see. Both eyes will be tested this way.
- Fluorescein angiogram: Another test that may be used. This is done if earlier tests showed positive for macular edema. A dye is injected into the patient’s arm. A camera is then used to take photos of the patient’s retina. The dye will travel through blood vessels. With the help of Fundus photography, the photos are taken with a specialized fundus camera once the dye reaches the retina. It can help to determine how much damage has been done to the patient’s macula.
- Dilated eye exam: Another standard test is the dilated eye exam. It provides a more thorough examination of the patient’s retina. With this test, the specialist can sometimes also see cysts in the eye. It can also help identify leakages in blood vessels. A drop is placed in the eye. The pupils are then dilated. Special tools are used to examine the retina once the pupils have dilated5.
- Optical coherence tomography: The purpose of this test is to identify the retina’s thickness. It helps to determine how much swelling affects the macula. A special light is used during the procedure. A camera is used alongside the light. It helps to provide a view on the cell layers that the retina is made up of. That includes the choroidal layer that contains the connective tissues and lies between the sclera and retina. This test is sometimes used before and after treatment. It helps the specialist keep track of the treatment progress.
- Amsler Grid: If the specialist needs to identify changes in central vision, the Amsler Grid test may be used. It is a highly accurate test. Even insignificant change to the patient’s central vision can be detected with this test.
How Can It Be Treated?
Treatment is a rather complicated process when it comes to macular edema. The first part of the procedure is for the specialist to determine the cause of the condition. In diabetic macular edema, diabetes would be the cause identified.
Treatment will usually start by addressing the underlying cause identified by the specialist. To treat the inflammation, Triamcinolone is administered after eye drops. In diabetic patients, a revision of the current treatment program may help to improve diabetes.
This could possibly reduce the rate at which diabetes damages nerves, blood vessels, and other parts of the patient’s body.
Acetonide injections are used for treating the eye. Also, Lucentis Genentech is used to prevent the formation of new blood vessels causing it to be the first drug to be approved by the FDA in the treatment of DME.
Additionally, the damage dealt with the retina is also treated. Several treatment options might be helpful in this case.
Fluocinolone acetonide implants (for the eye) may be used as an effective treatment option for the build-up fluid in the retina. The focal laser procedure can help treat the fluid and blood vessel leakage as well.
Some of the treatment options that may be advised to the patient include:
- Anti-VEGF Injections: These are also known as intravitreal injections. This is a standard treatment option for patients with vitreomacular traction. A numbing drop is placed on the affected eye. A thin needle is then inserted into the eye. A particular medication is then injected into the vitreous gel of the eye. This is a fluid that is located in the center of the patient’s eye. There are three drugs used in the injection. This includes Bevacizumab (trade name: Avastin), Lucentis, and Eylea. Vascular endothelial growth factor activity is blocked by these drugs. This growth factor activity promotes the growth of blood vessels. This is helpful with the VEGF activity is overactive. Based on a randomized trial, the treatment may help to prevent further leakage in the macula. Clinical evidence6 notes that this treatment is not a practical option for everyone.
- Corticosteroid Treatment: Corticosteroids can sometimes be used as an anti-inflammatory method. The drugs can be administered in a few different ways. This includes eye drops or pills. Injections are sometimes also used around the eye region. There are also FDA-approved implants that are sometimes used. This includes Illuvien, Retisert, and Ozurdex7.
How Can It Be Prevented?
Preventative strategies have been proposed for patients at risk of diabetic macular edema. It is crucial for a diabetic patient to ensure the condition is effectively treated.
The patient should strictly follow the treatment program. This means taking appropriate drugs. A healthy diet with a reduced amount of sugar, along with daily exercise, is crucial.
The maintenance of healthy blood sugar levels is essential. Additionally, patients should take note of other vitals too. This includes blood pressure and cholesterol levels.
All of these factors can contribute to complications. There are several strategies to keep all of these factors in balance. The patient should, however, be aware of their current vitals. This ensures they can know when they are doing better or when their vitals are changing negatively.
There are nonsteroidal anti-inflammatory drugs sometimes used to prevent macular edema too. These are usually provided as an eye drop. They help to reduce swelling in the eye.
In turn, there is a lower risk of blood vessel damage in the area of the retina. This could possibly prevent the leakage that contributes to macular edema. Avastin and Lucentis block the abnormal growth of the vessels, including the leakage.
A regular eye exam with a highly qualified eye specialist can be helpful too. The patient should ensure they mention any changes in vision to the eye specialist. This ensures further investigation can be done. When eye-related conditions are identified early on, then there is a bigger chance of a more effective treatment program to be implemented.
Conclusion
Diabetes is a condition that can cause a number of complications in the body. Focus is often placed on lower limb amputations. There are, however, many other problems that a diabetic patient can face. This includes diabetic macular edema.
The condition affects the eyes. Individuals with diabetic macular edema experience poor vision. There are several management strategies available. Individuals should also realize that sometimes, the disease can be prevented.
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