Slow the Progress of Diabetic Macular Edema

Did you know that May is “Healthy Vision Month.” While you should take care of your eyes 365 days a year, dedicating May to healthy vision stands as a reminder to be proactive in taking care of your eyes. Certain health conditions, including diabetes and high blood pressure, can increase the risk of eye diseases. By taking care of your health through proper diet and exercise, you also are protecting your vison.

Diabetes and eye complications

Healthy Vision month calls attention to a serious eye complications caused by diabetes, including diabetic retinopathy and diabetic macular edema. Diabetic retinopathy occurs when high blood sugar damages blood vessels in the retina, which is the light-sensitive layer of cells in the back of the eye. The damaged blood vessels can swell and leak resulting in blurry vision. New blood vessels may grow, but they are fragile and bleed. Diabetic retinopathy usually affects both eyes. In the advanced stage, vision may become completely blocked if there is a lot of bleeding.

Diabetic retinopathy is a leading cause of blindness in American adults, and it affects over one in four people living with diabetes, while 4 percent have severe cases of retinopathy.[1] When untreated diabetic retinopathy can lead to diabetic macular edema. This eye complication occurs when the blood vessels damaged by retinopathy start to leak blood and vitreous fluid into the macula (the light-sensing membrane in center of the retina that helps you clearly see details and objects in front of you) causing it to thicken or swell. About half of those affected by diabetic retinopathy will develop diabetic macular edema, which can range in severity from cloudiness and floaters to complete vision loss. [2]

Anywhere along the progression of diabetic retinopathy, you may experience diabetic macular edema. However, as retinopathy advances or gets worse, the incidence of diabetic macular edema also tends to increase.[3]

Diabetic macula edema can affect people with Type 1 or Type 2 diabetes; however, it is more common in people with Type 1. Women with gestational (pregnancy-related) diabetes also are at risk.[4]

Diabetic macula edema risk factors

Among the non-modifiable risk factors for diabetic macula edema are:[5]

·         Age: As you get older, retinal cells may not function as effectively as they did, increasing the risk of the condition.

·         Genetic predisposition: Having a family history of diabetic macula edema or other related eye conditions may increase the risk.

·        Duration of diabetes: The longer you have diabetes, the risk developing complications such as diabetic macula edema increases.

Indications of diabetic macula edema symptoms

During an eye exam, your doctor may detect signs of diabetic macular edema. They include[6]

• Swelling or thickening of the macula
• Fat and protein deposits in macula
• Microaneurysms, which are bulges in blood vessels that leak blood or fluid in the eye, develop
• Damage to capillaries (small blood vessels) 
• Leakage of blood vessels
• Abnormal (new) blood vessel growth caused by excess vascular endothelial growth factor (VEGF)

Diabetic macular edema symptoms

Diabetic macular edema symptoms may include:

·         Blurry or double central vision

·         Dark or empty spots in central vision

·         Difficulty reading or seeing faces clearly

·         Floaters

·         Difficulty seeing colors

·         Seeing straight lines as bent or curved

·         Difficulty seeing if there is a glare or bright light

·         Difference in how you see the size of an object when you look at it with only one eye and then the other

Diabetic macular edema treatment options

Diabetic macular edema treatment options will depend on the severity of the swelling and how your eye responds to care. Among treatment options: [7]

Anti-VEGF injections: They are the most common diabetic macula edema treatment options. Medications injected directly into the eye to block vessel growth and reduce leakage of fluid can improve vision or keep it from worsening.

Steroid injections or implants: They are another diabetic macula edema treatment option, especially if the anti VEGF drugs do not work well. They reduce inflammation and swelling. However, they may increase the risk of cataracts or higher eye pressure.

Laser therapy: The use of a focused laser seals off leaking blood vessels can help slow or stop vision loss in some people.

Eye surgery: Surgery (vitrectomy) is an option in more advanced cases when the eye’s vitreous fluid is pulling on the retina or bleeding is significant. The surgery aims to relieve pressure and prevent further damage.

Lifestyle changes that can slow macular edema

If you receive a diagnosis of diabetic macular edema, you should consider the following lifestyle changes:

Exercise

Good eye health benefits from exercise. It can slow diabetic macular edema.  According to studies, there is more blood flow to the retina tissue after a workout. They key is to get moving even with moderate exercise, such as taking a walk, riding a bike, or water aerobics. Before starting any exercise program, check with your doctor.[8]

Adjust your diet

Eat a healthy, balanced diet to keep your blood sugar under control. A research review published in March 2022[9] in the journal Nutrients found that proper diet – and exercise – are major factors in reducing the risk of diabetes and the ophthalmic complications it can cause. The review found individuals who increased their physical activity and changed their diet lowered the development of diabetic retinopathy from 29 to 58 percent.

In one study, the consumption of oily fish at least twice a week was associated with a nearly 60 percent reduction in the risk of retinopathy. Another study reported that 85-141 grams of dark fish (salmon, mackerel,. swordfish, sardines, bluefish) consumed weekly versus never was related to an almost 70 percent reduced likelihood of retinopathy.

Researchers also found the vitamins, minerals, fiber, and other nutrients found in fruits and vegetables may help prevent or slow retinopathy. Also avoid sugary drinks and oils with a lot of trans fats, opting instead for oils like olive, canola, soy, corn, sunflower, and peanut. [10]

Control your blood pressure

Diabetes can result in high blood pressure, which can worsen diabetic macular edema. To lower your blood pressure

·         Lose weight

·         Limit alcohol

·         Exercise

·         Lower stress

Stop smoking

Smoking can cause further damage to your blood vessels. [11]

In addition to making changes in your lifestyle, schedule a diabetic eye screening at least once a year. If diabetic macular edema is caught early, treatment will be more effective and may slow progression of the disease.