9 Ways to Keep DME From Progressing
Wondering how to stop diabetic macular edema (DME) from getting worse—and how to start preserving your vision? Smart move. “It’s much easier from a medical standpoint to maintain good vision than to regain lost vision,” says David Eichenbaum, M.D., a retina specialist and director of research for Retina Vitreous Associates of Florida in Tampa Bay, FL. “With treatment and a system that controls diabetes, you have a great future of many years of excellent visual acuity.”
Lower Elevated Blood Sugar
The most important way to decrease DME progression? “Blood sugar control,” says Abdhish R. Bhavsar, M.D., a retina specialist in Minneapolis and clinical spokesperson for the American Academy of Ophthalmology. “Optimizing blood glucose control slows down progression.” DME happens when diabetes causes diabetic retinopathy (DR), a progressive eye disease. DR leads to damaged blood vessels in the retina and swelling in the macula, or DME. Take your diabetes meds and check blood sugar levels as directed. Also, ask your doctor about a hemoglobin A1C test, which shows average blood sugar level over a three-month period. Aim to keep blood sugar levels under 7%.
Watch Your Blood Pressure
Blood pressure (or hypertension) is another number to watch. High BP can increase risk for blocked retinal arteries. “Hypertension can cause damage to the retina, even in the absence of diabetes,” Dr. Bhavsar says. Hypertension is a major risk factor for the progression of DR, and controlling BP has been shown to prevent vision loss from DR, according to a study in The Journal of Human Hypertension. Normal BP is less than 120 in the upper number (systolic) and less than 80 in the lower number (diastolic)—high BP is considered 130-139 or 80-89. Quitting smoking, exercising, and healthy eating habits can all positively impact blood pressure.
Keep Tabs on Cholesterol
The last measurement to scoot into the healthy range is cholesterol. If LDL cholesterol and triglycerides are too elevated over time, not only will cardiac vessels be affected, but retina vessels will be too, says Dr. Bhavsar. “Elevated blood lipids can lead to vessel damage, in a similar manner that vessel damage occurs in the heart. That’s why it’s so important to control cholesterol when you have diabetes,” Dr. Bhavsar says. A healthy level of LDL cholesterol is less than 100mg/dL and for triglycerides, less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L).
Exercise Like Your Vision Depends on It
We know exercise helps lower blood sugar, which is a way of preventing DME progression. Making lifestyle modifications, like moving more and eating better, can halt vision progression from DR/DME, and can also help reduce other risk factors associated with worsening outcomes from diabetes, says David Eichenbaum, M.D., a retina specialist and director of research for Retina Vitreous Associates of Florida in Tampa Bay, FL. Aim for 150 minutes of moderate-intensity exercise per week, according to the American Diabetes Association. Break it into stints, and know brisk walking counts!
Eat to Lower Blood Sugar
A healthy diet can also help reduce DME progression. While he’s not a dietitian, Dr. Eichenbaum notes that the right approach is one that your diabetes specialist deems the best at lowering high blood sugar levels. “That’s the secret,” Dr. Eichenbaum says. “As long as you’re achieving your A1C goals, and your fasting blood sugar goals, that’s the diet that works.” Aim for more fruits and veggies, less processed foods. If you could use some coaching, ask your doctor to recommend a nutritionist.
See Your Eye Doctor Regularly
Get a comprehensive dilated eye exam at least once a year—or more as directed by the eye doctor—to stop progression of DME. If you have Type 1 diabetes, your first full ophthalmic examination (with dilated pupils) should be 5 years after onset and annually after; if you have Type 2 diabetes, your first examination should be at the time of your diagnosis and then yearly after, according to The American Academy of Ophthalmology.
Consider Preventative Treatment
If you have a form of diabetic eye disease like DR but haven’t yet started DME treatment, you might want to discuss prophylactic therapy with your eye doctor, Dr. Eichenbaum says. Fortunately, today’s treatments, which include anti–vascular endothelial growth factor (Anti-VEGF) injections, steroid implants, and/or laser treatments, are relatively painless. “Treatments for disease that is not yet affecting your vision can be beneficial, especially if you’ve lost vision in one of your eyes with diabetic eye disease and you want to protect your vision in the second eye, which hasn’t developed DME yet,” he says.
Stick to Your DME Treatments
Committed to stopping DME from worsening? Then get your treatments, as scheduled, and don’t miss any. Your eye doctor and their staff understand the burden of regular treatments for DME, Dr. Eichenbaum says. “We’re all working to see you less often if we can yet maintain good results. We don’t want diabetics to spend their whole lives in the doctor’s office, but they’ve got to spend some of it there once they reach a certain level of disease to stay healthy and stay well-sighted.” Guaranteed, it’s time well spent.
Kick the Butts
If you mean to stop smoking every year—now’s the time. Not only is quitting smoking good for your overall health, it could also be a positive for your DME. The toxins in cigarette smoke damage the eyes’ tiny vessels, increasing the risk of blocked retinal blood vessels and age-related macular degeneration. “It’s important for everyone to stop smoking,” Dr. Eichenbaum points out. If you need help with quitting, ask your doc.
- Blood Pressure and DR: The Journal of Human Hypertension. (2012). “How does hypertension affect your eyes? pubmed.ncbi.nlm.nih.gov/21509040/
- Optimal Blood Pressure: American Heart Association. (2021). “Understanding Blood Pressure Readings.” heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
- Optimal LDL Cholesterol: American Heart Association. (2020). “HDL (Good), LDL (Bad) Cholesterol and Triglycerides.” heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides
- Optimal Triglycerides: MedlinePlus. (2020). “Cholesterol Levels: What You Need to Know.” medlineplus.gov/cholesterollevelswhatyouneedtoknow.html
- Exercise Benefits: American Diabetes Association. (2021). “Blood Sugar and Exercise.” diabetes.org/healthy-living/fitness/getting-started-safely/blood-glucose-and-exercise
- AAO Eye Exam Recommendations: American Academy of Ophthalmology. (2020). “Comprehensive Adult Medical Eye Evaluation PPP 2020.” aao.org/preferred-practice-pattern/comprehensive-adult-medical-eye-evaluation-ppp