How to Handle Diabetic Macular Edema Complications
If you have diabetes, you’re probably aware that the disease can affect vision. But the connection between the two can be a bit, well, fuzzy. Here’s how it goes: High glucose levels spur abnormal blood vessels in the eye—known as diabetic retinopathy (DR). Left untreated, about 10% of people with DR will develop diabetic macular edema (DME), swelling that can cause central vision loss in the eye’s macula. What else is associated with progressing DME? We asked three top ophthalmologists about complications from this serious eye condition.
Let’s zoom in for a minute on how the eye is structured. In the back of the eye, a layer of cells called the retina senses light and sends signals to the brain that allows you to see. In the middle of the retina, the macula controls central vision; in the center of the macula, a cluster of cones called your fovea makes it possible to see sharp details. DME can damage these structures and cause scarring, says Abdhish R. Bhavsar, M.D., a retina specialist in Minneapolis and spokesperson for the American Academy of Ophthalmology.
Retina Protection Is Possible
Damage to the retina may be irreversible, but you can avoid it altogether if DME is addressed in an early stage and you stick to your treatments. “In the short run, DME usually does not lead to substantial vision loss unless the macular edema is severe,” says Dr. Bhavsar. “But in the long run, DME progression does lead to vision loss, and that’s why we treat it.” Stick to your doctor’s recommendations for treatment and adhere to the schedule—don’t skip even one appointment.
Guarding Against Vision Loss
If chronic retinal changes are left untreated, the vision loss they cause can be permanent. The good news: Treatments, including anti-vascular endothelial growth factor (anti-VEGF) injections, can help stop future progression of diabetic macular edema. “Sometimes we can get vision improvement,” says Dr. Bhavsar. On the other hand, if the swelling caused by DME has been there a while, it's harder to treat. See your eye doc now!
Blood Vessel Damage
Beyond the damage DME can cause to the eye, there are additional associated complications you might not think of. “Diabetes attacks the small blood vessels of the body—the essential pathways that help supply blood and nutrients to the brain, peripheral nerves, kidneys, and eyes,” according to Gary H. Cassel, M.D., an ophthalmologist at Greater Baltimore Medical Center (GBMC) in Cockeysville, MD, and author of The Eye Book: A Complete Guide to Eye Disorders and Health.
Harm to Other Organs
The level of damage to the eye with DR/DME indicates the impact of diabetes on the body overall, says David Eichenbaum, M.D., a retina specialist and director of research for Retina Vitreous Associates of Florida in Tampa Bay, FL. The eye, via the dilated eye exam, is a unique window into the blood vessels everywhere in the body, Dr. Eichenbaum says, and can tip your doctor off to damage to other organs.
Increased Risk of Heart Disease
A 2017 study published in JAMA Ophthalmology found that people with DME or proliferative diabetic retinopathy (another severe type of diabetic retinopathy) were at higher risk of cardiovascular disease (CVD), which includes coronary heart disease, stroke, or death from cardiovascular causes than people with healthy eyes. The likely reason: Damaged blood vessels. If you have DME, it’s a good idea to have your doctor keep close tabs on your heart health.
Risk of Amputation
Diabetes can lead to peripheral artery disease (PAD), a condition which spurs blood vessels to narrow, reducing blood flow to hands and feet. For this reason, diabetics have an increased risk for lower-limb amputations. And for reasons researchers are still trying to sort out, DME appears to be strongly and independently associated with lower limb amputation in type 2 diabetic patients. If you have DME and experience poor blood flow to your extremities, be sure to bring it up with your doctor.
Increased Risk of Kidney Disease
Scientists have found a connection between renal (kidney) disease and untreated DME, as well as diabetic retinopathy (DR), according to a study published in JAMA Ophthalmology in 2018. A spot of good news though: Researchers determined that aggressive treatment for chronic kidney disease may also play a role in preventing the deterioration of DR and therefore may keep DME from worsening as well.
Yearly Eye Exams Are Key
Since DME often has no symptoms, you may not notice that anything is amiss until you start to lose vision, so seeing your eye doctor once a year for a full ophthalmic exam (especially if you’re diabetic) is a must. “All diabetics need regular eye examinations and must follow up with their ophthalmologists if they are receiving treatment for diabetic-related eye problems like DME,” Dr. Cassel says. Proactive monitoring can help you keep your eyesight sharp.
About the Retina: American Academy of Ophthalmology. (2020.) “Retina.” aao.org/eye-health/anatomy/retina-103
About the Macula: American Academy of Ophthalmology. (2016.) “Macula.” aao.org/eye-health/anatomy/macula-6
About the Fovea: American Academy of Ophthalmology. (2017.) “Fovea.” aao.org/eye-health/anatomy/fovea
DME and CVD: JAMA Ophthalmology. (2017.) “Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.” pubmed.ncbi.nlm.nih.gov/28472362/
DME and Amputations: Medicine (Baltimore). (2015.) “Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients: A Multicenter Observational Study.” pubmed.ncbi.nlm.nih.gov/26287408/
DME and Renal Disease: JAMA Ophthalmology. (2018). “Association of Abnormal Renal Profiles and Proliferative Diabetic Retinopathy and Diabetic Macular Edema in an Asian Population With Type 2 Diabetes.” jamanetwork.com/journals/jamaophthalmology/fullarticle/2664082