The Truth Behind 9 DME Myths
It's hard enough keeping the terminology straight when it comes to diabetic macular edema (DME)—though you'll soon be an expert in eye anatomy!—without worrying about all the myths that are out there surrounding this treatable condition. We talked to the experts to clear up the biggest misconceptions about DME and the outlook for your vision (it's sunny, we promise!).
DME Myth #1: I Will Go Blind
While vision loss was once inevitable with DME, that's thankfully no longer the case. Laser treatment has cut the likelihood of vision loss by a whopping 50%, says Raj Maturi, M.D., a clinical spokesperson for the American Academy of Ophthalmology and a retina specialist at Midwest Eye Institute in Indianapolis, IN. And since the development of anti-vascular endothelial growth factor (anti-VEGF) medications to treat DME, the incidence of blindness among all diabetics has dropped to less than 10%. So if you keep up regular eye exams and treatment, you can count on a clear-eyed future!
DME Myth #2: If I Have Diabetic Retinopathy, I Will Get DME Eventually
Not necessarily. It's true that diabetic retinopathy—the presence of abnormal blood vessels in the eye due to high glucose levels—is the most common cause of macular edema. But of the nearly eight million Americans who live with diabetic retinopathy, only about 10% also have DME, though your individual risk of developing it increases the longer you've been living with diabetes. Healthy lifestyle habits that keep your blood sugar in check can lower your risk and possibly bring your chances of DME down even further.
DME Myth #3: The Treatment for DME Is Painful
Another easy one to dispel. Yes, anti-VEGF medications are eye injections and, yes, that sounds pretty scary. But “the anxiety is worse than anything,” says Michelle Liang, M.D., an assistant professor of ophthalmology at Tufts Medical Center in Boston, who reports that the most uncomfortable part of the procedure is probably when the eye is swabbed with betadine (a topical antiseptic) to clean it. Since numbing drops or gel are always used, the most you might feel during the injection itself is some slight pressure. “Most patients say: ‘That was it?’ afterwards,” assures Dr. Liang.
DME Myth #4: A Single Shot Will Cure My DME
For now, no. Typically, multiple anti-VEGF injections are required over the course of four years to treat the damage caused by DME and prevent further deterioration, says Dr. Maturi. What you can expect: six to eight treatments (a single injection per eye constitutes a treatment) during the first year, five during the next, three in the third year, and just one in the fourth. The good news: The aggressive treatment protocol “won't continue for life,” assures Dr. Maturi. As long as you keep your diabetes and blood pressure under great control, you may never need to be treated for DME again.
DME Myth #5: Once My Vision Improves, I Can Stop Treatment
Though you will need a few years of treatment for long-lasting results, you may well notice a dramatic improvement in your vision (if your eyesight was compromised to begin with) right away. After just one anti-VEGF treatment, many patients experience a four-to-five letter gain, says Dr. Maturi. That means you'll be able to decipher a whole extra line on the eye chart that was previously blurry. That's great, right? Yes! But it also leads some patients to falsely believe that they don't need to continue treating their DME. To prevent relapse, you have to stick to the schedule.
DME Myth #6: Treatment Always Needs to Happen Immediately
If your vision is good (20/25 or better) and your DME is center involving (meaning it's in the fovea, which is the center of the macula), your doctor may want to hold off on treatment for the time being. Why? One 2019 study compared three different treatments in patients with DME: One group received anti-VEGF injections, one group underwent laser treatment, and the third group received no treatment at all. After two years, the study found that all three groups had comparable rates of visual acuity. So frequent eye exams to monitor changes might be best, if you meet the conditions.
DME Myth #7: Good Vision Means My Eyes Are Healthy
You're seeing just fine, so you figure everything is hunky dory with your peepers. If you have or are at risk for DME, though, don't count on it. “You can have serious eye problems and still have good central vision,” warns Dr. Liang. “Vision difficulties might not come up until later stages of disease.” Moral of the story: Stick with your regular eye exams (at least once a year; more if you have the more advanced “proliferative” diabetic retinopathy or DME) so you can catch and treat any changes right away.
DME Myth #8: Only People With Type 1 Diabetes Get It
While DME is more common among people with type 1 diabetes than those with type 2, it's still all too common in both groups. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) followed nearly 3,000 people with diabetes for 25 years and found that 99% of the type 1 participants and 60% of the type 2 group developed diabetic retinopathy, which can lead to DME. No matter what type of diabetes you have, it's incredibly important to—say it with us—visit your eyecare provider regularly.
DME Myth #9: Vigorous Exercise Could Worsen My Eye Condition
Au contraire! If you have nonproliferative (less-advanced) diabetic retinopathy or macular edema, physical activity is just what the doctor ordered! Exercise—along with a healthy diet—can go a long way in keeping your blood sugar under control, which in turn stops or slows the progression of ocular blood vessel damage. This myth does have a credible origin story, though: Vigorous aerobic exercise and strenuous strength-training may be ill-advised if you have proliferative (more severe) diabetic retinopathy. Talk to your primary care physician about your current exercise regimen or before starting a new one.
DME Prevalence: American Journal of Managed Care. (2016). “Overview of Diabetic Macular Edema.” ajmc.com/view/overview-of-diabetic-macular-edema
Treatment Evolution: The American Journal of Pathology. (2012). “A Brief History of Anti-VEGF for the Treatment of Ocular Angiogenesis.” ncbi.nlm.nih.gov/pmc/articles/PMC5691342/
DME in Type 1 vs. Type 2 Diabetes: Ophthalmology. (2008). “The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes.” pubmed.ncbi.nlm.nih.gov/19068374/
Exercise and DME: American Diabetes Association. (2006). “Physical Activity/Exercise and Type 2 Diabetes.” care.diabetesjournals.org/content/29/6/1433