Diabetic Macular Edema (DME) Overview
Diabetic Macular Edema (DME) is an eye condition that may occur among people who have had diabetes for a long time. Edema is swelling that occurs because fluid leaks out of blood vessels in the part of the eye that gives us sharp vision in the center of our visual field (the macula).
Among adults who have had diabetes for at least 20 years, 3 out of 10 will develop DME. Among adults who already have advanced diabetic retinopathy, 7 out of 10 will develop DME. As many as 24,000 Americans with diabetes go blind each year in the US as a result of diabetic retinopathy.
DME may be categorized as focal (small patches of DME damage in the center of the retina) or diffuse (widespread damage visible throughout the macula). An alternative way to classify DME is Clinically Significant Macular Edema (CSME), non-Clinically Significant Macular Edema (non-CSME), CSME with central involvement (CSME-CI).
Written by Jane Neff Rollins, MSPHShow All
Providers Who Treat Diabetic Macular Edema (DME)
As DME is diagnosed, treated, and managed, you may encounter the following team of doctors and specialists. Having a team of doctors or specialists with varied expertise will help diagnose the possibility of having DME more accurately, manage the condition more effectively, and help maintain your vision.
Endocrinologist - A medical doctor who specializes in the diagnosis and treatment of conditions affecting the endocrine system. The endocrinologist will help you manage the underlying diabetes, including helping you control your blood glucose (sugar) levels.
Ophthalmologist - A medical doctor who specializes in the diagnosis and treatment of diseases of the eye.
Optometrist – A person who is professionally trained and licensed to examine the eyes and prescribe and supply eyeglasses and contact lenses. If DME causes your vision to get worse, the optometrist can provide new eyeglasses to help you see better.
Vision Specialist - A person who is trained to assess your vision and help you manage daily activities if your vision gets worse. The Vision Specialist can help you find large type or audio books and learn to read Braille.
How to Prepare for Your DME Doctor Visit
Now that you have made your appointment with an ophthalmologist to manage your diabetic macular edema, you need to take certain steps before your visit in order to get the most benefit from it:
- Ask someone to drive you to and from the eye exam. It is likely the doctor will dilate your eyes, so you will not be able to drive yourself.
- Write down all the drugs you are currently taking, including prescription medications, over-the-counter medications, vitamin and mineral supplements, and herbs. Include the dose you take.
- Write down your medical history, including any eye problems that you have had in the past.
- Bring the eyeglasses and contact lenses that you currently use – for distance and for reading.
- Make an enlarged copy of the front and back of your health insurance card on a single sheet of paper. Use one as a master, and make a copy to leave at your doctor’s office.
Questions to Ask Your Doctor About Diabetic Macular Edema
From your initial diagnosis throughout your treatment and care, you will have questions about your diabetic macular edema. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition.
Questions About My Diagnosis
- What causes Diabetic Macular Edema?
- Will my vision continue to get worse? Could it get better or at least stay the same?
- What new symptoms can I expect? What symptoms are serious enough that I should call you right away?
- How often should I come in for an eye exam?
- Will I go blind?
- If I have DME in only one eye, will I get it in the other eye?
Questions About My Treatment
- What treatments are available for DME? Does treatment mean pills, eye drops, or surgery?
- When can we start treatment?
- Will I have to stay on treatment for the rest of my life?
- Is there a special diet or vitamin supplements that would help my vision?
- Are there foods that I should avoid with this treatment?
- Is there an operation that could restore my vision?
Questions About My Lifestyle & Family
- Do I have to stop driving?
- Can I still read, or will I have to learn Braille?
- Are there devices or vision aids that can help me continue to do the daily activities I want to do?
- Will changing my diet make any difference to my condition?
- Can I drink alcoholic beverages or would it make my vision worse? Can I continue to smoke?
- Is there an online or in-person DME support group I could join?
Common Tests or Labs to Diagnose Diabetic Macular Edema
The tests for diabetic macular edema look for changes in the structure of the eye caused by the fluid leaking into the back of the eye.
|Test||Why Test?||What Happens?||Result|
|Biomicroscopy||This test allows the ophthalmologist to see the structures of both the front and back of eye||The doctor inserts eye drops in the eye to dilate (widen) the pupil. The patient places his/her chin on the chin rest and the forehead against the strap. The biomicroscope includes a bright light. The patient moves his/her eyes as instructed while keeping the head still.||The doctor may see subtle signs of macular edema.|
|Optical Coherence Tomography||Measures the thickness of the retina, and identifies structural damage in the eye.||A beam of light is shone into the eye. The OCT device collects some of light that reflects from the inner structures of the eye and processes it with a computer into a multicolored picture.||This indicates if treatment is effective or if DME is worsening.|
|Fluorescein Angiography||The ophthalmologist can see swelling or leakage from blood vessels in the retina and how widespread it is.||The ophthalmologist injects a colored dye (fluorescein) into a vein in the arm. The dye travels to the eyes and enters the blood vessels in the back of the eye. The dye highlights the retinal blood vessels so a special camera can photograph them for use in diagnosis.||The doctor may see narrowed or leaking blood vessels.|
Common Medications and Treatments for Diabetic Macular Edema
Outcomes with DME are best when patients with diabetes keep their blood sugar under control.
|Drug Category||How it works|
|VEGF inhibitors||Decreases leakage of fluid from blood vessels in the eyeReduces edema (swelling) in the center part of the retina
Improves vision or at least prevents further deterioration of vision in most patients
Decreases leakage of fluid from blood vessels in the eye
Reduces edema (swelling) in the center part of the retina
Improves vision or at least prevents further deterioration of vision in many patients
Note: corticosteroids may increase the risk of glaucoma by increasing intraocular pressure and the risk of cataract development
|Laser photocoagulation||Decreases leakage of fluid from blood vessels in the eyePrevents further vision loss but does not restore vision that has already been lost|