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Diabetic macular edema (DME)

High blood Sugar in diabetics damages retinal blood vessels

DME: Causes and development

Diabetic Macular Edema, or DME for short, is an eye condition occurring in diabetic people - both type 1 and type 2. Diabetes is characterized by increased levels of sugar (glucose) in the blood stream. Medication, e.g. insulin, is used to lower blood glucose, with the aim of getting it back into the normal range. Consistently high blood sugar can damage blood vessels, with the first signs appearing in the smallest veins, called capillaries.

Many diabetics, particularly those with poor blood glucose control resulting in too-high blood sugar levels over long periods of time, have damaged blood vessels in the retina, the tissue in the back of the eye that carries the vision cells. This condition, called 'diabetic retinopathy' affects up to 80% of all patients who have had diabetes for ten years or more.

One aspect of diabetic retinopathy is diabetic macular edema or DME: Fluid leaks out of the tiny, fragile, already damaged blood vessels in the back of the eye, and accumulates in the macula. This leads to swelling of the tissue and blurred vision. Eventually, these patients can be left functionally blind, unable to read, drive, and even care for themselves. DME is not a disease in itself but a 'side effect' of diabetes. It is also a significant cause of vision loss in diabetics. Approximately one-third of all people living with diabetes for twenty years or more will develop DME.

Regular visits to eye specialists are essential for all diabetics, so signs of vessel damage in the retina (diabetic retinopathy) or diabetic macular edema can be detected as early as possible. If blurred vision occurs, the patient should visit an eye specialist immediately.

Treatment of DME

The most important prevention is maintaining good blood sugar control, but once DME has developed it is too late for prevention.

A number of procedures are performed to manage the disease. Doctors can try to stop the bleeding and leakage in the macula via a special laser procedure, or anti-inflammatory medicines can be injected directly into the eye in the hope of reducing the leaks from the damaged vessels and the inflammation in the tissue that may follow. If bleeding in the clear centre of the eye (the vitreous gel) is the cause of blurred vision, it is also possible to remove the affected part of the gel and replace it by injecting an isotonic salt solution.

Also modern medications called Anti-VEGF therapies are being tested in DME.

New drug under investigation for DME

Bayer is currently investigating a new drug of the Anti-VEGF type which must be injected directly into the eye. The drug has already been successfully tested in another type of retinal disease. A Phase II clinical trial has shown encouraging results.

Advice for patients
Every body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.