On DiabetesTeam, members frequently discuss eye symptoms such as 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. DME can lead to serious vision problems, so catching it early is important.

Here’s what you can expect if you’re starting to notice 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 the eye senses 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.

High blood sugar levels from diabetes can damage the delicate blood vessels in the retina. 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 14 people with diabetes.

Diabetic macular edema affects about 1 in 14 people with diabetes.

People with type 2 diabetes are more likely to develop DME than those with type 1 diabetes. Doctors strongly recommend yearly eye exams for all people living with diabetes.

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

• Amsler grid or visual field testing to check for issues with central and side vision
• Fluorescein angiogram to monitor 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 get regular eye checkups.

Symptoms of Diabetic Macular Edema

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

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

What Is Vision Like With Macular Edema?

With macular edema, vision can become blurry or wavy, especially in the center of your field of view. It may be harder to read, see faces clearly, or pick out small details. Sometimes, lights may seem too bright or colors may not look as strong as before.

In the beginning stages of DME, you might not notice any vision changes or other symptoms. The condition may affect one eye or both. If just one eye is affected, it can take longer to recognize a problem. That’s why regular eye exams are essential. If the edema keeps getting worse, you may have trouble with daily activities like reading or driving.

Progression of DME

DME doesn’t take the same course for everyone. In one study, researchers followed 350 people with center-involved DME (CIDME) receiving placebo (inactive treatment) over three years to understand how their condition progressed. 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. The results showed that older participants and people with more severe diabetic retinopathy had worse vision outcomes.

DME doesn’t progress the same for everyone. In one study, more than 37 percent of participants had no change in vision, and 16 percent had a major decline in vision.

Another study examined whether non-center-involving DME could progress to CIDME. Among the 72 participants, about 26 percent developed CIDME within two years, putting them at greater risk of vision problems. This study also found that a longer duration of diabetes was a risk factor for this progression.

Regular Eye Exams To Monitor Progression

Progression of DME can be hard to predict, so your doctor will want to see you more often to monitor your eyes. If you have mild disease, yearly visits may be enough. But as the condition progresses, you’ll need eye appointments every four to six months or as often as every three months.

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

DME can quickly change from causing no symptoms to threatening your eyesight. The best way to monitor it is through regular checkups that allow your doctor to examine the back of your eye.

Treatment Options

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

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 healthcare 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 see if noninvasive prescription eye drops help. They may start with nonsteroidal anti-inflammatory eye drops. In other cases, eye drops containing steroids may be prescribed. However, eye drops aren’t generally effective for DME.

Try Eye Injections

If managing diabetes and using eye drops don’t improve macular edema, the next step may involve injections.

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 some small risks are involved, the procedure is generally safe and effective. Treatments are usually ongoing.

There are now a few kinds of injection medicines for DME. Most are anti-VEGF drugs, but some newer types target two pathways in the eye at once. In certain cases, doctors may use steroid injections or tiny implants. Some newer implants release the medicine slowly over time, so you need fewer treatments.

Consider Eye Surgery or Laser Treatments

If all other treatments haven’t worked, you may need eye surgery. A procedure called a vitrectomy may help reduce swelling.

Another surgical option is laser surgery, which seals off leaky blood vessels in the eye to control and reduce swelling and bleeding. Laser treatment may be combined with vitrectomy or used alone.

How Effective Is Treatment?

With proper treatment, DME symptoms can be stabilized or improved. Some people 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.

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 can lead to serious consequences and significantly affect independence and quality of life. However, 60 percent of people with diabetes don’t get regular eye exams, according to the CDC.

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.

Join the Conversation

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