Early detection of macular edema can prevent vision loss
Having diabetes means that your body cannot control the level of sugar in your blood. It also means that you are at a higher risk for eye disease and vision loss. To prevent progression of vision loss, people with diabetes should monitor their levels of blood sugar, blood pressure, and also cholesterol. Having an elevation in any of these can cause complications to the blood vessels in the back of your eye. This area is called the retina and is responsible for your ability to have clear and precise vision.
When the blood vessels in the eye’s retina swell or leak, it can lead to diabetic retinopathy and eventually diabetic macular edema (DME). It may also lead to collateral circulation of abnormal new blood vessels that can form on the surface of the retina. You may have an early stage of diabetic eye disease and be totally unaware. The key is early detection.
In the words of Ben Franklin, an ounce of prevention truly is worth a pound of cure. He also said that a little neglect may breed great mischief. He certainly knew the importance of prevention. In regards to eyesight, early detection, lifestyle changes, and treatment may help prevent vision loss.
What is Macular Edema?
The lifetime risk for diabetics to develop macular edema is nearly 10%. Elevations in blood sugar can lead to kidney disease with hypertension, fluid retention and changes in serum protein. This in turn may result in swelling of the retina due to leakage of fluid from the tiny blood vessels within the central portion of the retina (macula). This sensitive area contains many nerve endings called cones that are responsible for detecting color. As macular edema develops, visual blurring may occur in the center of, or just to the side of the center of vision. Because diabetic macular edema is classified into several different types with specific treatments, it is important to seek out an ophthalmologist or retinal specialist as soon as you perceive any visual changes. In fact, if you are a diabetic it is important to have your retina evaluated yearly anyhow as there may not be any symptoms early on.
Symptoms of Macular Edema
You may have blurriness or difficulty having the pinpoint vision required to read or thread a needle. Straight lines may appear wavy or there may even be patches of vision loss. It is possible that you may not have any symptoms at all. Up to 55 percent of individuals with DME are unaware that they even have the condition.
People who are at greater risk of developing DME are those who have poor blood sugar control, pregnant women, individuals with hypertension and elevated cholesterol. African-Americans, Native Americans and Hispanics are especially at risk. You cannot change your gene pool, however you should do all you can to keep your blood sugars, cholesterol and blood pressure readings in check.
Obtain a comprehensive dilated eye exam yearly. This means not just going to the neighborhood eye glass shop but to a qualified Ophthalmologist that is trained to proactively screen for retina disease.
Know your numbers. Make sure you know what your A1C is. It is the gold standard for diabetes screening and treatment, and is far more accurate than fasting blood sugar levels. It indicates what your blood sugar averages over a period of time have been. Keeping the levels below 7.0 is considered better for diabetics. Make sure that your blood pressure is within normal limits. Keep your cholesterol down as well. All of these things may be controlled in part by maintaining a healthy weight and exercising. A diet low in fat, sodium and simple carbohydrates is crucial. Take all of your medications as prescribed and notify your physician of any changes that indicate elevation of glucose such as increase in thirst, appetite or urination.
Treatment of Macular Edema
In the early stages of diabetic retinopathy there may be no treatment other than close observation and controlling risk factors. Once it progresses to macular edema, you may need to be treated with laser surgery. This is an outpatient surgery that consists of the doctor using a laser to create several hundred miniscule laser burns in the area surrounding your macula that is leaking. This in turn slows the leakage and at the same time reduces the amount of fluid in the retina. You may require more than one treatment. Laser surgery can reduce the risk of total blindness by 90 percent. However it may not be able to totally restore vision that has been already lost.
The doctor may opt to inject medication into the area instead of, or in addition to surgery. Medications include steroids and a group of new medications specific for macular edema. Research out of the National Eye Institute (NEI), found that prompt treatment with the drug Lucentis resulted in better vision than laser treatment alone or with steroid injections. This was true with or without laser treatment. When treated with medications such as Lucentis, and two other similar drugs, Avastin and Aylea, there was a reduction in fluid leakage. In addition there was less growth of damaging new blood vessels in the retina. Additional studies are underway comparing these three medications to see which ones are more effective. It is possible that they all have their own benefits, allowing for more treatment options.
Take away message
Even with good control of blood glucose, hypertension and cholesterol levels, there is still a risk of developing diabetic eye disease such as retinopathy and macular edema. . However, studies show that careful management of and yearly exams can slow the onset and progression of eye disease with the opportunity for early treatment. Ben Franklin may have said it is easy to see and hard to foresee, however if there is anything that can be done to preserve your precious gift of sight, why wouldn’t you?
National Eye Institute: Facts about Diabetic Retinopathy.
FDA Advisory Committee Unanimously Recommends Approval of Lucentis for Treatment of Diabetic Macular Edema (DME).