Diabetic Macular Edema: Have No Fear

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Diabetic Macular Edema: Have No Fear

Diabetic Macular Edema,

 

 

 

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.

Diabetic Macular Edema Occurs In Almost Everyone

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).

Laser Treatment is Only Approved Treatment

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.

Laser is Painless

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.

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Comments
  • KS April 1, 2011 at 12:31 am

    Thanks for this post Randy. Although for me it is a bit scary to read (I have DME), it is better to be informed. If there anythink diet wise, or supplement wise (bilberry, etc.) that can aid in the reduction of DME? Anything else I as a person can do other than tight glucose control? Thanks so much.

    • Randall V. Wong, M.D. April 7, 2011 at 7:43 am

      Dear KS,

      I am not aware of any proven supplements that may aid in the reduction of DME. There are some reports that keeping tight control of your triglycerides may be helpful. It is very hard to know.

      Thanks.

      Randy

  • mke April 27, 2011 at 6:18 pm

    My brother is a diabetic and was told today he has macular edema. His vision is 2200. Can treatment restore his vision? He had a traumatic experience as a child and is extremely fearful of doctors and needles. Should he have anything to be afraid of? Thanks, mike

    • Randall V. Wong, M.D. May 4, 2011 at 7:30 am

      Dear Mike,

      The answer is yes…he should be afraid of losing more vision if he doesn’t seek treatment.

      Treatment for macular edema, due to diabetes, may be treated with laser or intraocular injections of avastin, lucentis or steroid. The injections don’t hurt, but for someone who is afraid of needles this is probably not too comforting.

      I usually start with laser treatment…it doesn’t hurt at all. If he were my patient and required injections, maybe a trip to the operating room would be in order.

      Randy

  • Diane Schoell May 11, 2011 at 1:53 pm

    Dr. Wong, Last Friday you performed the laser procedure (photo coagulation) on my left eye. As you could probably tell, I was extremely nervous going into this procedure. But, as you state in your publications, the procedure is painless! I could not believe It took only several minutes and I felt absolutely nothing during or after the procedure. I drove myself to and from the Woodburn Surgery Center where the procedure was performed with no problems. I made sure I had my sunglasses for the drive home – it was a very sunny day – no different than having a dialated exam. The staff at the Woodburn Center was extremely friendly and “on time”. I have already made my appointment to have the same procedure done on my right eye in three weeks – and, have absolutely no anxiety about doing so. Thank you Dr. Wong and the Woodburn Center staff for your kindness! I am no longer afraid of eye exams! I am better focused on my diabetes control and look forward to keeping my vision for a very long time. …. Diane

    • Randall V. Wong, M.D. May 16, 2011 at 5:35 pm

      Dear Diane,

      Thanks for taking the time to write about your treatment. It should be helpful to others to hear from you that you “survived.”

      Look forward to seeing you soon. Thanks again

      r

  • Landon Budge June 15, 2011 at 10:43 pm

    Dr. Wong,
    Thank you for your blog post – it was very informative. Would you mind clearing up a few points of confusion for me?
    You say that laser treatment is the only FDA-approved treatment for DME, but I understand that Lucentis was approved by the FDA in 2010 for the treatment of macular edema. Am I misunderstanding this press release, or is Lucentis also an FDA-approved option now for the treatment of DME?
    Additionally, I am curious to know why you mention Avantis and Kenalog as alternative treatments, but not Lucentis. Is there a reason you mentioned only those two? Are they the most effective, or the only appropriate choices for some reason?
    Thank you in advance for helping me understand what options exist for DME treatment.
    (Link to FDA approval included below)
    http://www.drugs.com/newdrugs/fda-approves-lucentis-ranibizumab-macular-edema-following-retinal-vein-occlusion-2197.html

    • Randall V. Wong, M.D. June 20, 2011 at 10:02 am

      Dear Landon,

      Lucentis was approved for retinal edema CAUSED by retinal vein occlusions. It is NOT FDA approved for the treatment of retinal edema CAUSED by diabetic retinopathy, also known as DME.

      I usually don’t mention both Avastin and Lucentis because they are, in my opinion, so clinically similar that most surgeons use one or the other. I, like most, favor Avastin due to the economic differences.

      Thanks for asking!

      Randy

  • dian v August 2, 2011 at 10:22 pm

    hello doctor.
    i have just learned today that i have DME. i have no insurance, won’t be 65 until next fall, am under employed and was wondering if you could tell me a) about how much the laser treatment will cost? and b) if you know of any sources/resources that may offer help in paying for this treatment.
    thank you,
    dian

    • Randall V. Wong, M.D. August 7, 2011 at 10:25 am

      Dear Dian,

      I am sorry about your employment issues. I encourage you to do everything you can to get evaluated and treated early, if possible. How is it that you were diagnosed, but not able to get treatment?

      I am actually not sure how much we charge in northern Virginia for the treatment. The fee structure usually varies from state to state depending upon Medicare reimbursement….although there is no hard and fast rule about this.

      I would first make sure you get evaluated by a retina specialist so that you have an exact game plan and then you can calculate potential costs.

      Don’t give up!

      Randy

  • Rae January 4, 2012 at 6:49 pm

    I have just had my eyes evaluated for macular edema and am leaning toward the Lucentis injections…I was told that the laser could possibly leave a permanent blur which I am totally uncomfortable with…I am going to be 36 and concerned because my husband and I want to have children and cannot whle being treated…I am suppose to get re-evaluated after 3 months of injections but I am wondering just how long these injections take to work…My vision is 20/20 with no loss as of yet

  • Niño March 14, 2012 at 12:33 am

    Hello Dr. Wong,
    My father was just diagnosed with DME this week and what I would like to know is How long will it take for him to be able recuperate his vision? He had the injection on his left eye. In your opinion do you highly recommend that he will be able to see clearly again? What r the chances…. And how long should it take for him to start noticing a clearer vision?I’m worried that he won’t be able to see again. This week was his first visit to the doctor and on the same day he had the injection! Thanks so much!

    • Randall V. Wong, M.D. March 19, 2012 at 12:23 pm

      Dear Nino,

      The amount of fluid or the amount of macular edema varies from patient to patient and thus, I can only guess, how long it may take for your father’s vision to improve.

      I don’t know if he will ever see clearly, but in my experience, he can expect to see some difference within several weeks. Sometimes it takes a second or third injection before some difference is appreciated.

      Randy

  • New User March 24, 2012 at 8:44 am

    Dear doctor

    Nice helpful blog you have here. Thanks.
    This is a brief summary of my eye status, and i am looking for your thoughts on my situation and questions please.

    I have diabetic retinopathy in both eyes. For my left eye i have proliferative retinopathy and i have DME. I have had PRP laser for my left eye for retinopathy and recently 5 weeks back a laser for DME for my left eye.

    They have also said that my right eye has gone into proliferative stage and a laser has been booked in few weeks time and a clinically not significant edema in my right eye.

    My questions :

    1. From the PRP laser in my left eye (approx, 3000 shots), i have seen a slight dim in my vision during the nights compared to my right eye. I am able to manage this since it does not affect my lifestyle but do you think my situation will worse as time progresses i.e. would there be any more consequences of PRP laser.

    2. Couple of weeks after my DME laser for my left eye (120 shots), i have just recently noiced 2 things
    a. A small light grey patch just slightly under my exact central vision.
    b. When i look closely at any object for e.g. a laptop keyboard, slightly to top left and right of my exact central vision, i feel grey patch (blind spots ?) which i think i cant see through. This does not affect my exact central vision but slight above to it.

    Although i will be discussing these with my doctor in 2/3 weeks time (pending appt), I was just curious to know if you can tell me what you think is going on.
    Are these effects because of recent DME laser OR are these have to be of concern (e.g. any leaking /bleeding near central vision). The main thing is that I did not notice the 2b. effect for 3 weeks after my DME laser. It is only for the past 3 days i am noticing this.

    with my combined vision in both eyes, this is not affecting my lifestyle although i want to get to know your thoughts on this.

    Any help appreciated. I am sure your answers to the above will help others in this forum too.

    New User.

    • Randall V. Wong, M.D. March 30, 2012 at 8:21 am

      Dear New User,

      1. Dimming can be from direct effect of the PRP as in some people, dark/light adaption is decreased. The PRP principally affects the rods in the peripheral retina. On the other hand, some people get macular edema after the PRP and it blurs or dims the vision….

      Regardless, I would expect you to either get better or get used to the changes….I doubt worse.

      2. Really tough to say without examining you. Could be edema or laser burn….or blood. Sorry.

      Thanks for you comments about the blog and thank you for contributing.

      Randy

  • jeff September 5, 2012 at 10:35 pm

    i have dme in both eye and will be doing the laser treatment. it is my impression that this is not a cure per say. it is a way to prolong my vision, left untreated i will go blind. my question is there a point were the laser will not work and i will eventually go blind. If so how long will it take(months, years)after my first treat i went 4 year before i have to do it again. i would think that age is a factor.

    • Randall V. Wong, M.D. September 12, 2012 at 8:51 pm

      Dear Jeff,

      It’s unlikely you’ll go blind. The chance of severe vision loss is about0.8% in your lifetime…as long as you get regular examinations and treatment when needed.

      Randy

  • Lei December 6, 2012 at 8:55 am

    Hello Doctor:

    my father has DME, and he had laser treatment and injection sever months ago, however, he doesn’t feel better, I am wondering why?

    thank you

    • Randall V. Wong, M.D. December 7, 2012 at 6:17 am

      Dear Lei,

      DME is often treated not necessarily to improve vision, but to prevent further vision loss. This could be his case. Also, he may need more treatment and/or the edema usually takes months to improve.

      Be patient and ask his doctor specifically about improving the macular edema.

      r

  • Lei December 7, 2012 at 7:42 am

    Dear Doctor:

    thank you for your response, my father used to be a good tennis player, after he had DME, he lost confidence and can’t concentrate on the tennis sport, my questions are , 1),is he going to have good vision like before after some laser treatments ? 2) he always sleeps very late every night, is that one of the reasons why he doesn’t feel better? a good sleep will help?

    thank you

    • Randall V. Wong, M.D. December 12, 2012 at 8:24 am

      Dear Lei,

      It’s hard to say, but vision may improve with laser. Often the laser prevents further loss. I don’t think the sleeping is from the DME.

      r

  • Lyn R December 18, 2012 at 7:06 pm

    Hi Dr. Wong,
    My husband has sudden onset DME/hypertensive retinopathy – one day he could see, the next he couldn’t. He is newly diagnosed with diabetes (8 mos), but was told that he has likely had it for several years. His A1c is now below 6, and the blood pressure is stabilizing. He has had 4 lucentis injections in each eye, plus laser in the right eye. He was seeing definite improvement until this week. He was told that sometimes patients hit a plateau, and it may be all the “better” he can get – or not. That’s the first time we’ve heard that. All of them have told us that it’s possible he can return to what his eyesight was prior to the loss. What has been your experience? I know the best outcome is seen at 24 months – at least 3 lines improvement on the eye chart – from what I’ve read. He is really depressed, and I would like to offer some supportive info.

    • Randall V. Wong, M.D. December 25, 2012 at 11:32 pm

      Dear Lyn R,

      Improvement of 3 lines is terrific. I don’t know how good or bad his vision is without an exam.

      My experience is that often there is improvement, sometimes it is sustained, but often re-injections are needed.

      Noone should have promised him full return, but I’m not saying there is no hope…I just can only say so much based upon the information provided to me.

      Randy

  • JoelM December 27, 2012 at 9:34 am

    Dr. Wong,
    What happens if a microaneurysm found on (or in?) the macula starts to bleed? You can’t use a laser on it, to cauterize it, if it is on the macula, right?

    I went in to my ophthamologist with a symptom of a small gray spot near the center of my vision of my left eye. The doctor thought he could see (with slit lamp) a microaneurysm “just nasal to the fovea”. It was very small and did not appear in the tomography scan.

    It might not bleed; and it might disappear on its own. But, if it bled how could it be stopped (considering where it is located)? You say, “The idea of treatment is to prevent the fluid from ever reaching the macula.” I’m a bit worried.

    • Randall V. Wong, M.D. January 2, 2013 at 9:15 am

      Dear JoelM,

      I doubt what you are seeing correlates to the microaneurysm, especially if your doctor thought he saw something.

      If it were to bleed, more likely it will leak, but treatment with anti-VEGF or steroids is better than laser.

      Randy

  • Susie January 5, 2013 at 3:52 am

    I really would love to answer this question. My sister was admitted to hospital in 1984 for an infection at an injection site. She was 22 years old and had diabetes since she was 8. The needle was from a drug ie. cocaine – she had experimented a bit with drugs. In the hospital the infection got worse. they cut her arm open from wristo to bicep with a fasciotomy. She then got worse and they found no antibiotic would stop the infection and she got sepsis – her body swelled immensely and then she almost died but she survived, Shortly after – she began to lose sight in her central vision of her good eye – she had 20.20 in one eye at that time. THen her bad eye (runs in our family) also deteriorated quickly., Over time she had laser surguery but no improvement nad she lost one eye and got glaucoma in the other and ended up legally blind. She lived another 10 years and died from something unknown but she had organ damage, kidney damage at the time she died which could have been caused from teh infection. I have always wondered what role if any did diabetes play in this horrible sequence of events and is there any other explanation for what happened to her? Could she have gotten and infection in her arm from a needle, gone to the hospital, got a secondary infection and then blood poisoning sepsis just from being in the hospital and then gone blind from say epeinphrine or some other drug used in the hospital? OR can we say it was all from diabetes. I would sincerely like to know.

    • Randall V. Wong, M.D. January 8, 2013 at 3:26 am

      Dear Susie,

      Diabetes is a blood vessel disease. Normal blood vessels simply stop working. In many cases, multi-system shut down occurs due to insufficient blood reaching the desired organs.

      Your description about your sister sounds like bad diabetes, perhaps complicated by IV drug abuse.

      I am sorry for your loss.

      Randy

  • JVR April 7, 2014 at 9:47 am

    Dr. Wong

    I have NPR-DME in boths eyes. My Dr has done laser and Avastin injections in both. Usually I have to do an Avastin injections every 5 to 6 weeks. My question is What about SDM laser as Dr. Luttrull has explained? And What are the chances of going blind from this condition. Thanks.
    JVR

    • Randall V. Wong, M.D. April 13, 2014 at 10:32 pm

      JVR,

      Subthreshold Micropulse Diode laser is indeed promising. I am sure that it will gain a foothold as a treatment for DME. It’s very eary and really has yet to catch on.

      The chances of your going blind, from diabetic retinopathy (any stage), is less than 1% as you have already been diagnosed and examined.

      Randy

  • Santosh joshi April 23, 2014 at 3:15 am

    Dear Dr.

    One month back I have undergone Laser treatment for central serous retinopathy with optic nerve head pit and last week they did eye check but there is improvremnt in pit, they said we can wait for one more month later we can decide what we can do next,moslty they will go for surgery,I am not understanding one thing that at first visit they said central serous retinipathy but after laser they are telling cystoid macular edema…please can you clarify my doubt…

    thanking you
    santosh

    • Randall V. Wong, M.D. May 10, 2014 at 8:55 am

      Santosh,

      They may be using the terms synonymously, or, serous detachment caused by serous fluid underneath the top layer of the retina vs. cystoid macular edema which is fluid within the top layer of the retina.

      Sorry for the confusion.

      Randy

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