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How Does Vision Change as Diabetic Macular Edema Progresses?

Medically reviewed by Paul B. Griggs, M.D.
Posted on June 14, 2024

On DiabetesTeam, members frequently discuss eye symptoms like blurry vision and dry eyes. Sometimes, these eye issues are related to changes in blood glucose (sugar) or medication. Other times, they’re caused by an underlying complication of diabetes. Vision changes also can be a normal sign of aging or an unrelated condition, like cataracts.

Diabetic macular edema (DME) is a common eye problem that affects people with diabetes. Although it may progress at a different rate for everyone, there are some telltale signs you should never ignore. As it can lead to serious vision problems, it’s important to catch it early.

Here’s what you can expect if you’re starting to experience symptoms of DME.

What Is Diabetic Macular Edema?

DME is a potential complication of diabetic retinopathy. In retinopathy, tiny blood vessels called capillaries that carry oxygen and nutrients to the retina are damaged.

To understand DME, let’s learn a bit about eye anatomy. The nerve tissue that lines the inside of the back of the eyeball is called the retina. This is where we sense light, so it’s essential for good eyesight. The macula is the central part of the retina. The cells in the macula are responsible for detecting fine visual details.

The macula is part of the retina, the area of the eyeball that allows us to sense light. The macula is required for seeing details. (Adobe Stock)


High blood sugar levels from diabetes can damage the delicate blood vessels in the retina. As a result, the damaged blood vessels may leak, causing the macula to swell and not work properly. This is called DME, and it affects about 1 in every 14 people with diabetes.

People with type 2 diabetes are more likely to develop DME than those with type 1 diabetes. That’s why doctors strongly recommend yearly eye exams for people living with diabetes.

If your eye doctor suspects a problem, they may do additional tests, such as:

  • Amsler grid and/or visual field testing to help check for issues with your central and side vision
  • Fluorescein angiogram to monitor the blood vessels in the retina
  • Optical coherence tomography to evaluate the optic nerve and retinal thickness

To prevent DME from affecting your vision, make sure to go to regular eye check-ups.

Symptoms of DME

Ideally, your eye doctor will detect signs of DME before you start to notice symptoms. But if you have any of these issues, it may be time to schedule a check-up:

  • Blurred vision
  • Double vision
  • Reduced color vision
  • Floaters
  • Headaches
  • Objects appearing as different sizes when viewed by one eye versus the other
  • Dark spots
  • Straight lines looking curvy
  • Trouble seeing when there are bright lights


Up to 90 percent of diabetes-related vision loss is preventable with regular eye exams and early treatment.

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In the beginning stages of DME, you might not have vision changes or other symptoms. Sometimes, people have changes in both eyes. But other times, just one eye is affected. If the vision in only one eye is changing, it can take longer to recognize that there’s a problem. For this reason, it’s so important to have your eyes examined at the doctor’s office. If the edema keeps getting worse, you may have trouble with daily activities like reading or driving.

Progression of DME

DME doesn’t progress the same for everyone. A study of 350 people with center-involved DME (CIDME) receiving placebo (inactive treatment) were followed over three years to understand how their condition would progress. CIDME affects the center part of the macula, which is crucial for vision. More than one-third of study participants — 37.5 percent — saw no change in their vision, and 16 percent had a major decline in vision. The study found that older participants and those who had more severe diabetic retinopathy had worse vision outcomes.

Another study followed people with non-center-involved macular edema to see if their condition would progress to center-involved DME. Of the 72 people in this study, 26.3 percent progressed to CIDME within two years. Progressing to CIDME means the individuals were at greater risk of vision problems. This study identified the amount of time someone has had diabetes as a risk factor for progression from non-center-involving to center-involved DME.

Regular Eye Exams To Monitor Progression

Because the progression of DME can be hard to predict, your doctor will want to see you more often to monitor your eyes. For mild disease, they may continue with yearly visits. But as the condition progresses, you’ll need to have an eye appointment every four to six months or as often as every three months. DME can quickly change from causing no noticeable vision changes to threatening your eyesight. The only way to keep track of it is by going in for regular check-ups to get a deeper look into your eyes.

Treatment Options

DME becomes a bigger problem when it goes undiagnosed for too long. Once your doctor knows what’s wrong, they can offer several effective ways to monitor and treat DME. Here’s what they may suggest.

Manage Diabetes Better

With DME, it’s crucial to get blood sugar levels under control. If you need more support to manage diabetes, ask your health care provider about a diabetes group class or a referral to a registered dietitian to help with meal planning.

Use Eye Drops

In less severe cases, your doctor may treat DME with a noninvasive prescription eye drop. They may start with nonsteroidal anti-inflammatory eye drops to see if they reduce eye inflammation. In other cases, eye drops containing steroids may be prescribed.

Unfortunately, eye drops are generally not an effective treatment for DME.

Try Eye Injections

If managing diabetes and using eye drops isn’t enough to improve macular edema, the next step may be to try injections.

Because the progression of diabetic macular edema can be hard to predict, your doctor will want to see you more often to monitor your eyes.

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VEGF stands for vascular endothelial growth factor. This substance is overproduced by the diabetic retina and can cause fluid leakage and abnormal blood vessel growth. Anti-VEGF injections reduce abnormal blood vessels. They also help stop the leaking from blood vessels, which is responsible for swelling. Although there are some small risks involving the procedure, it’s generally safe and effective. Treatments are usually ongoing.

Consider Eye Surgery or Laser Treatments

If all other treatments don’t seem to be working, you may need eye surgery. A procedure called a vitrectomy may help reduce swelling.

Another surgical option is laser surgery. Laser treatment can help seal off leaky blood vessels in the eye to control and reduce swelling and bleeding. Laser surgery may be combined with the vitrectomy procedure or as a standalone treatment.

How Effective Is Treatment?

With the proper treatment, DME symptoms can be stabilized or improved. Sometimes, people can regain their full vision. According to the Centers for Disease Control and Prevention (CDC), up to 90 percent of diabetes-related vision loss is preventable with regular eye exams and early treatment.

DME is one example of how uncontrolled diabetes leads to serious consequences and significantly affects a person’s independence and quality of life. Despite this finding, research from the CDC shows that 60 percent of people with diabetes don’t get regular eye exams.

By taking advantage of the monitoring tools available, you can control how diabetes affects your vision and other aspects of your life. If you have trouble affording medical care, ask your doctor about reduced-cost options or free screenings. These resources can help you keep your vision and stay healthy.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 155,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Are you screened by an ophthalmologist for diabetic retinopathy and other diabetic eye disease every year? How much of a priority is eye care in your overall diabetes care plan? Share your comments below, or start a conversation by posting on your Activities page.

    Posted on June 14, 2024
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    Paul B. Griggs, M.D. is certified by the American Board of Ophthalmology. Learn more about him here.
    Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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