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Update on Prevention, Diagnosis & Treatment of Diabetic Macular Edema ( DME) Part 1

Learn about diabetic macular edema (DME), its symptoms, risk factors, and the latest in prevention, diagnosis, and treatment. Get insights from expert A. Paul Chous, OD, explore OCT imaging, and understand key associations. Stay informed to protect your vision.

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Update on Prevention, Diagnosis & Treatment of Diabetic Macular Edema ( DME) Part 1

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  1. Update on Prevention, Diagnosis & Treatment of Diabetic Macular Edema (DME) Part 1 A. Paul Chous, MA, OD, FAAO Specializing in Diabetes Eye Care & Education Tacoma, WA Adjunct Instructor, Nova Southeastern University College of Optometry Principal Investigator for the Diabetes Visual Function Supplement Study (DiVFuSS)

  2. What IS DME? • Fluid accumulation and retinal thickening within the macula as a result of diabetes mellitus Cross-sectional view via OCT Ophthalmoscopic view of DME

  3. What Are The Symptoms? • Often asymptomatic in the earliest stages that are most amenable to treatment • More severe disease results in visual distortion, loss of color perception & loss of detail vision • May result in ‘legal blindness’ but not total blindness, unless concomitant proliferative retinopathy with tractional retinal detachment

  4. What Are the Risk Factors? • Established risk factors for diabetic macular edema include disease duration, HbA1c, BP, obstructive sleep apnea and cigarette smoking • T1DM, Latino or Black race, HTN, diabetic nephropathy and neuropathy significantly increase risk per recent retrospective analysis of 440,000 patients Ophthalmology. 2009 Mar;116(3):497-503 Retina. 2012 Oct;32(9):1791-8. Diabetes Res Clin Pract. 2013 Jun;100(3):298-305 Association for Research in Vision & Ophthalmology 2013, Seattle

  5. DME & A1c • 27% of pts in the DCCT had DME by 9 years Diabetes 2010;59:1244–1253 • Each 1 point increase in HbA1c (e.g. from 7.5% to 8.5%) raised the odds of DME by 37% in WESDR over 25 years of follow-up . WESDR = Wisconsin Epidemiologic Study of Diabetic Retinopathy Ophthalmol 2009; 116(3):497-503

  6. Risk for DME w TZDs (thiazolidinediones) • Hi-dose TZDs may increase risk • T2DM Tx w pioglitazone (ActosTM) increased odds of DME by 5x • Risk increased 21x with concomitant insulin • Analysis not controlled for BMI, and pioglitazone pts were generally “sicker” • If Rx’d, lower doses may reduce risk of DME Arch Intern Med. 2012 Jul 9;172(13):1005 EASD Sept 2013 Abstract #67

  7. CSME and Center-Involved DME • CSME (clinically significant macular edema) established treatment criteria per ETDRS (Early Treatment Diabetic Retinopathy) findings • Diagnosis dependent on retinal thickening & proximity to the fovea • Based on stereoscopic, clinical examination • Center Involved DME means foveal involvement requiring therapy

  8. Optical Coherence Tomography (OCT): THE Most Sensitive Tool to Detect DME (98.6% sensitivity) • 1-1.7 um wavelength, non-ionizing light • Resolution to 1 micron • 17,000 scans/sec • Can detect DME long before clinical exam BUT, not all detected DME requires treatment • 30% of patients with DME detected by OCT are not detected by clinical examination • These patients are 4x more likely to develop CSME Ophthalmology.2004 Apr;111(4):712-5. Ophthalmologica.2013;230(4):201-6.

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