Can Diabetic Macular Edema (DME) Be Prevented? What to Know About Early Detection and Risk Reduction

Diabetic macular edema (DME) is a complication of diabetes that causes fluid buildup in the part of the eye that controls clear, detailed vision. You can’t always prevent it, but managing blood sugar, cholesterol, and blood pressure, as well as screening for DME, can protect your vision.

Diabetes can affect a person’s eye health, sometimes leading to DME. High blood sugar can form compounds that damage blood vessels and damage the retina, a light-sensitive layer of tissue at the back of the eye that allows you to see. When the barriers between the retina and the rest of the eye are damaged, fluid builds up in the macula, the structure responsible for sharp, high-resolution vision.

This means that managing your blood sugar can reduce your risk of developing DME. Your hemoglobin A1c (HbA1c) measures how well your blood sugar is controlled over time: an HbA1c of 7% or higher is associated with a higher risk of DME.

Additionally, managing cholesterol levels can also help prevent DME. Evidence suggests that taking statins, a cholesterol-lowering medication, may reduce the risk of DME by reducing inflammation and preserving the function of the eye’s blood vessels. However, research is mixed.

Blood pressure is another important metric to track: According to a 2023 study, the risk of DME is 24% higher in people with both diabetes and high blood pressure (hypertension).

Talk to your doctor about your target ranges for blood sugar, blood pressure, and cholesterol. If some are out of reach, medications or lifestyle changes can help.

There is no way to completely prevent DME, but managing your blood sugar, blood pressure, and cholesterol levels can reduce your risk. Certain lifestyle changes (in addition to medications) can help you achieve these goals, including:

• Stay active: Exercise helps your body process insulin more efficiently, which promotes better long-term blood sugar control. Additionally, physical activity helps you lower your blood pressure, lower your cholesterol levels and manage your weight.
• Maintain a healthy diet: Choosing vegetables, fruits, lean proteins and whole grains can support healthy blood sugar, blood pressure and cholesterol.
• Stop smoking: Although some research has shown that people who smoke may actually have a lower risk of DME, it’s important to remember that smoking is associated with more inflammation, poorer blood sugar control, and higher blood pressure in people with diabetes.

DME often has no symptoms in its early stages. That’s why regular eye exams are crucial, even when your eyes feel perfectly fine.

Experts recommend getting a comprehensive dilated eye exam at least once a year if you have diabetes. Your eye care professional will use drops to widen your pupils and see inside your eye to detect early signs of DME or other eye diseases.

If something is wrong, an ophthalmologist (a doctor who specializes in eye conditions) can investigate with one of two common tests:

• Optical coherence tomography (OCT): A non-invasive scan that measures fluid buildup in your retina
• Fluorescein angiography: A test where a dye is injected into a vein to reveal any leaks in the retinal vessels

Don’t wait until your next scheduled exam if you notice something is wrong. Contact an ophthalmologist or optometrist immediately if you experience:

• Blurred or distorted vision
• Colors that appear washed out or discolored
• Dark spots or wavy lines in your vision

If DME is detected early, treatment can prevent further visual damage. This is one of the best reasons to keep up with your annual eye exams.

The most common treatment is anti-VEGF (anti-vascular endothelial growth factor) injection. These medications are injected directly into your eye to reduce inflammation and improve blood vessel health, which should prevent fluid from seeping into the retina.

Laser treatment is another option. It reduces fluid leakage into the macula and helps stabilize your vision, although it may have harmful side effects. Doctors may also use steroid injections or eye surgery to treat DME.

Your eye doctor will help you determine which treatment is best for you, based on the severity of your DME and how your body responds.

If you have diabetes and haven’t had a dilated eye exam recently, scheduling one is the best place to start. Ask your healthcare provider to refer you to an eye care professional experienced in diabetes-related eye conditions.

To reduce your risk of DME or slow progression, make sure you have healthy blood sugar levels, blood pressure, and cholesterol levels. If any of these parameters are abnormal, your doctor can help you develop a plan to keep it within a healthy range.