Diabetic Maculopathy | What it is
DM, that is, Diabetic Maculopathy, is a condition that affects the macula, the central part of the retina responsible for sharp vision. It often develops as a complication of diabetic retinopathy, a condition caused by prolonged high blood sugar levels damaging the blood vessels in the eyes
Cause Of Diabetic Maculopathy
Diabetic Maculopathy occurs when blood vessels near the macula become leaky or blocked, leading to fluid buildup or protein deposits. This can result in macular oedema (swelling) or hardening of the retina. If the deposits are close to the fovea, it may progress to Clinically Significant Macular Oedema (CSME)
- High blood sugar: Poorly controlled blood sugar levels damage the small blood vessels in the eye.
- Smoking: Smoking increases the risk of diabetic retinopathy.
- Inactivity: A lack of physical activity can contribute to diabetic macular oedema.
Symptoms of diabetic maculopathy
Diabetic maculopathy (DM) is a complication of diabetes that affects the macula — the part of the retina responsible for sharp, central vision. When damaged, it can make everyday activities like reading, driving, or recognising faces difficult.
Common symptoms include:
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Blurred central vision: Vision may appear hazy or unclear, making it hard to read text or recognise people’s faces.
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Distorted vision: Straight lines may seem bent, wavy, or warped, a common early sign of macular involvement.
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Loss of sharpness: Fine details become harder to see, even with glasses, affecting tasks that require precision, such as sewing or writing.
These symptoms usually develop gradually and may affect one or both eyes. Early detection is vital, as untreated diabetic maculopathy can progress to permanent vision loss.
Diagnosis of diabetic maculopathy
Several eye tests help detect diabetic maculopathy and assess its severity:
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Fundus ophthalmoscopy: An eye specialist examines the retina and macula using a special lens and light to look for swelling, leaking blood vessels, or other diabetic changes.
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Fluorescein angiography: A dye is injected into a vein in the arm, and as it travels to the eye, photographs are taken to highlight any leaking or damaged blood vessels in the retina.
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Optical coherence tomography (OCT): A modern, non-invasive imaging test that uses light waves to create detailed cross-sectional images of the retina. OCT allows for early detection and monitoring of macular swelling and helps guide treatment decisions.
Treatment Options
1. Laser Photocoagulation
This is one of the most common treatments for diabetic maculopathy:
- How it works: A laser is used to seal leaking blood vessels in the retina. This prevents further fluid buildup and stabilises the condition.
- Procedure: The treatment is usually done on an outpatient basis. Local anaesthetic drops are applied to numb the eye, and a special lens is used to focus the laser on the retina.
- Effectiveness: While it doesn’t typically improve vision, it helps prevent further deterioration.
- Side Effects: Temporary blurred vision, light sensitivity, or mild discomfort
2. Anti-VEGF Injections
Anti-VEGF (Vascular Endothelial Growth Factor) medications are a newer and highly effective option:
- Examples: Drugs like Lucentis (Ranibizumab) and Eylea (Aflibercept).
- How it works: These injections block VEGF, a protein that promotes abnormal blood vessel growth and leakage. This reduces swelling in the macula.
- Procedure: The medication is injected directly into the eye under sterile conditions. It’s a quick procedure, often done in a clinic.
- Frequency: Multiple injections may be needed over several months.
- Effectiveness: Can significantly improve vision in many cases.
- Side Effects: Mild discomfort, redness, or a slight risk of infection.
3. Intravitreal Steroids
- Examples: Ozurdex (Dexamethasone implant).
- How it works: Steroids reduce inflammation and swelling in the retina.
- Procedure: Similar to anti-VEGF injections, the steroid is delivered directly into the eye.
- Effectiveness: Can be effective in reducing macular oedema, but the benefits may be temporary.
- Side Effects: Increased risk of cataracts or elevated eye pressure (glaucoma)
4. Vitrectomy
This is a surgical option for advanced cases:
- How it works: The procedure involves removing the vitreous gel (the clear gel inside the eye) and replacing it with a saline solution. This helps clear blood or scar tissue that may be affecting the retina.
- When it’s used: Typically reserved for cases where other treatments haven’t worked or when there’s significant damage.
- Effectiveness: Can improve vision in some cases, but recovery may take time.
Prevention of DM
Controlling blood sugar, blood pressure, and cholesterol can help reduce the risk of developing DM. People with diabetes should also attend annual diabetic eye screenings.
Understanding Diabetic Retinopathy and how to reverse it
DM can occur in the non-proliferative or proliferative stages of diabetic retinopathy. Complications of untreated proliferative diabetic retinopathy can cause severe vision loss