Diabetic Macular Edema (DME)

Diabetic Retinopathy (DR) is a microvascular complication of diabetes mellitus with a fairly high prevalence rate. Further stages of DR will cause Diabetic Macular Edema (DME).


Diabetic Retinopathy (DR) is a microvascular complication of diabetes mellitus with a fairly high prevalence rate. Further stages of DR will cause Diabetic Macular Edema (DME).


One of three people with Diabetes Mellitus have their diseases progressed to complication that effects eyes or Retinopathy1.


One of the causes of blindness and vision impairment is Diabetes Mellitus. The disease is known as Diabetic Retinopathy (DR).


Further stages of DR will cause Diabetic Macular Edema (DME). People with DME experience decreasing vision quality, such as the presence of black dot, blurry vision, and wavy vision. When left untreated immediately, complimented with uncontrolled blood glucose level, the process to blindness can potentially be faster.


DME occurs when fluid leaks into the center of the macula, the light-sensitive part of the retina responsible for sharp, direct vision. Fluid in the macula can cause severe vision loss or blindness.


DM’s patients who chronically have the disease, regular changes of blood sugar can cause damage to the small blood vessels in the retina and complications with severe consequences in terms of morbidity2,3. To maintain and improve the quality of eyesight, it is essential for the patients to be immediately given DME appropriate treatment in order to maintain their eyesight. Without the treatment, by using eye acuity examination (ETDRS), DME patients can lose two rows of their eyesight within the first 2 years4. With early diagnosis and appropriate treatment, a patient's likelihood of vision loss can be stabilized and even restored, thus enabling them to revert to normal life4,5.


There are two objectives of DME patient treatment, first is the stability of eyesight to prevent worsening the retina, edema, and hyper-reflective repair foci. Another objective is restorative therapy by maintaining or improving visual acuity correction or Best Corrected Visual Acuity (BCVA) and edema. There are several treatments for DME such as a special laser that can close the capillary leak, reduce swelling and steroids. There is also the latest treatment with anti-VEGF therapy. VEGF is a blood vessel growth factor. When injected into the eye, this drug inhibits VEGF resulting in the formation of new blood vessels and swelling can be reduced. Some research has shown that anti-VEGF therapy is more effective in improving visual acuity correction than laser or steroids treatment for DME. The earlier the treatment, the bigger chance the patients can be saved.


DME is one of the most frequent reasons for severe vision impairment in the working-age population4. As the majority of people under 50 years old are still working, vision impairment may lead to loss of productivity and earnings2. Vision impairment related to DME may lead to daily tasks and role difficulties, decreased patient quality of life, and depression6,7. The direct annual cost per patient with DME is approximately twice as high as those of patients with diabetes alone8. Visual impairment goes beyond the individual. Social and financial costs have an impact on the social and financial burden of families, communities and within the country2.


References :
1.    http://atlas.iapb.org/vision-trends/diabeticretinopathy/
2.    IDF. Diabetes Melitus Atlas. Sixth Edition. 2013, http://www.idf.org/Diabetes Melitusatlas/downloadbook.
3.    Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and Diabetes Melitus among U.S. adults aged 40 or older. Diabetes Melitus Res Clin Pract. 2007;77:485-488
4.    Ciulla, T.A. et al. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Melitus Care 2003;26:2653- 64.
5.    Boyer, D. et al. Anti-vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema. Ther Adv in Endo and Metab. 2013;4(6):151-169.
6.    Davidson, J.A. et al. How the diabetic eye loses vision. Endocrine.2007;32(1):107-116.
7.    De Groot, M. et al. Association of depression and Diabetes Melitus complications: a meta-analysis. Psychosom Med. 2001; 63(4):619-630.
8.    Vision for the future. Parliament magazine. 2011;320:22.

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