Diabetic macular edema (DME) is swelling in the retina caused by diabetic retinopathy. More specifically, the swelling is located in the macula, the functional center of the retina.
DME is the most common “side effect” or complication of diabetic retinopathy. It should not be feared, but rather, it should be expected. Almost every diabetic patient will develop some degree of macular swelling in their lifetime.
Diabetes can be considered a disease of blood vessels, caused in some way by high sugar levels. For reasons that are not completely known, the blood vessels in the retina start to leak, both blood and the fluid component of blood.
As the leakage nears the macula, we get concerned as swelling in the macula leads to loss of vision. The idea of treatment is to prevent the fluid from ever reaching the macula. If fluid has already developed, treatment may prevent further leakage (and thus preserve vision) or possibly decrease the swelling (and maybe improve vision).
The only FDA approved treatment for diabetic macular edema, aka clinically significant macular edema (CSME), is laser treatment. The laser is used to burn those areas around the macula that are leaking. Often, the laser results in stablizing the retina and preventing further leakage.
The laser does not hurt. There are no nerve endings underneath this portion of the retina. The treatment may last just a few minutes and is accomplished while you are sitting at the laser. In fact, the visit should mimic a routine dilated exam.
After treatment, no “healing” is really needed. I personally do not recommend any drops, patches or time off from work. Your doctor’s recommendations may vary.
Laser treatment for diabetic macular edema takes several months to start working. After 4-6 months, I can usually tell if more treatment will be needed.
What Does This Mean?
Laser treatment for diabetic macular edema is the gold standard. While DME is quite common, the treatment works best if instituted early in the disease process, preferably while the vision is 20/20.
Not all patients can be treated with laser. Other treatments for DME include intraocular injections of Avastin or Kenalog. Using any of these tools, almost everyone with diabetic retinopathy may be treated.
Regardless, fear not, the treatment for the disease is quite successful in preventing further vision loss. It is painless, safe and effective.