What Is Diabetic Macular Edema
Diabetic Macular Edema happens when you get leaking blood vessels in the eye caused by diabetic retinopathy and the fluid builds up in the central part of the eye retina- (macula). It is the most common cause of sight loss in diabetics.
What Causes Diabetic Macular Edema
Your eyes need a good constant supply of blood to stay healthy when blood sugar control is bad, it causes damage to the blood vessels which then leak (diabetic retinopathy). People with type 1 diabetes have a 90% chance of having some degree of retinopathy after 10 years while those with type 2 diabetes have a 70-80% chance of damage. Only around 8% of diabetics will have a loss of vision that they notice. The other 92% will not have many symptoms and retinopathy is only detected at the eye exam. The macula is in the centre of the retina and gives us the best vision.
Treatment For Diabetic Macular Edema
There are a few options for treatment but it’s important you get treatment early because if left untreated the leakage will permanently damage the retinal nerve cells, which at present there is no cure for and is irreversible. The first action you will need to take is to control your blood sugar levels as best you can, also make sure you have not got a high blood pressure. By keeping both these levels as close to normal as you can stop diabetic retinopathy from happening or getting worse.
Because you have Diabetic Macular Edema your body makes too much of a protein called VEGF. This protein causes your blood vessels to grow too quickly, which makes them weak and leak blood and fluid into your retina and macula. Anti-VEGF Injections block the protein to help stop this from happening.
There are three anti-VEGF medicines used. These are injected into the centre of your eye, you won’t feel anything as your eye will be totally numbed first.
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
- Aflibercept (Eylea)
Treatment can last for up to 6 months with you getting an injection once a month, after 6 months you may still get the injections for up to 2 years depending on how quickly they are working. When your blood vessels have stopped leaking you will then start to see better
Possible Complications Of Anti-VEGF Injections
- eye irritation or discomfort
- bleeding inside the eye
- floaters or a feeling of having something in your eye
- watery or dry, itchy eyes
Often called steroids, these target inflammation. Your doctor might prescribe steroids to lessen swelling in your retina.
Corticosteroids come in 2 options, either by injection or a tiny implant in your eye. This implant releases small doses of the steroid slowly, so you won’t need a series of injections. You don’t need to have the implant taken out it dissolves over time.
Anti-VEGF Injections work better than steroids, and steroids can cause more eye problems like cataracts and glaucoma. So steroids usually won’t be your first treatment option.
Macular Laser Surgery
Lasers will slow down the leaking blood vessels with the aim of sealing them, this will then bring down swelling of the retina allowing you to see much better.
The laser is given to one eye at a time, so if both eyes are bleeding you will need to go back in a few weeks for treatment on your other eye. Sometimes one treatment with laser maybe enough to stop the vessels leaking, it really depends on how bad the vessels are leaking, I personally had about 6 sessions of laser treatment.
If you are been treated with anti-VEGF injections, you may also be given laser if the injections alone don’t seem to be helping. If like me after having laser surgery you start to suffer from dry itchy eyes your doctor can prescribe some eye drops to ease this.
Possible Complications Of Laser Treatment
- reduced night or peripheral (side) vision – some people may have to stop driving as a result of this
- bleeding into the eye or objects floating in your vision (floaters)
- being able to “see” the pattern made by the laser on the back of your eye for a few months
- a small, but permanent, blind spot close to the centre of your vision
When the fluid builds up in the eye or after a serious bleed, it can be impossible for the eye doctor to see inside, just like you can’t see out they can’t see in. This makes it hard for them to do the treatments. At this stage and usually as a last resort they will perform an operation on your eyes called a vitrectomy. This involves removing the vitreous humor gel which is filled with blood from the leaky vessels.
You will have 2 incisions on your eye, one for a drill to drill away the vitreous gel and suck out the gel, and a light in the other so the surgeon can see what he is doing. This sounds daunting and really scared me, but this procedure was painless after the numbing drops and gave me back some eyesight after being virtually blind for 12 months due to the leaked blood from my eye vessels not draining from the eye and staying within the vitreous humor gel.
Once the blood-filled vitreous gel is removed this allows the surgeon to seal the leaking vessels with laser treatment at the same time.
Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.
Even after treatment for diabetic retinopathy, you’ll need regular eye exams. And you may need further treatment.i
Possible Risks Of Vitreoretinal Surgery
- developing a cataract
- further bleeding into the eye
- retinal detachment
- fluid build-up in the cornea (outer layer at the front of the eye)
- infection in the eye
The yearly cost of anti-VEGF treatment can be more than $20,000, whereas the cost of vitrectomy can be under $10,000.
On The Day Of Treatment
Each of the above treatments is carried out as day surgery, which means you will not need to stay in the hospital overnight. You will be given an eye exam then have numbing drops in your eyes before any treatment starts. Do not drive to your appointment as you will not be able to drive after any of the above treatments until the day after. Bring some sunglasses to wear after treatment as your eyes will not tolerate light.
You will be given an emergency number to ring if you have any problems within the next 24 hours. You will have an eye patch which can be taken off the day after treatment. If your eyes are hurting you can take regular pain killers which should ease any pain. Your eyes will become tired very easily for a few days after treatment, try to rest them as much as possible.
What You Can Do To Help Avoid Diabetic Eye Problems
Keep your blood sugar, blood pressure and cholesterol under control, eat a healthy balanced diet, lose weight, stop smoking, and exercise regularly.
If you have DME, using low vision aids (magnifying devices, special eyeglasses, or telescopes) can help maximize your current vision, according to the CDC. And low vision devices don’t just improve your quality of life — they can also keep you safe and help you maintain your independence.
Garry (Type 1)