Diabetic macular edema (DME)—a thickening of the center of the retina—is the most common cause of visual loss due to diabetes. Treatments for DME have improved dramatically in recent years and typically involve a series of injections of biologic agents into the middle cavity of the eye to prevent vision loss. When treated early, these injections are effective at preventing vision loss in about 90% of DME cases and sometimes result in vision gain. However, if some vision has already been lost, substantial improvements in vision occur only in about 50% of cases.

“It’s important to initiate DME therapies before substantial visual loss occurs,” says Neil M. Bressler, MD. “Healthcare providers need to ensure that patients with diabetes are aware that their disease can affect their eye.” Experts recommend annual eye examinations to monitor for early signs of vision problems, but studies suggest that many adults with diabetes do not get the proper type or frequency of eye care.

Poor Awareness

Dr. Bressler and colleagues had a study published in JAMA Ophthalmology that assessed the prevalence of eye care and awareness of eye disease and visual impairment among people with DME. Among the 800 self-reported patients with diabetes in the study, a photograph of the retina confirmed that 238 had diabetic retinopathy without DME and 48 had diabetic retinopathy with DME. Only 60% of those with DME reported receiving an eye exam with pupil dilation within the past year, and only about 46% said that their physician informed them about changes in their eyes. Nearly 30% of patients with DME already had vision loss in the affected eye at their initial examination.




It is concerning that fewer than half of people with diabetes-related eye disease were told about their condition, says Dr. Bressler. “Many patients likely are missing out on treatments that can save their eyesight. Many people with diabetes are simply not getting the care they need to prevent visual impairment and blindness.”

Moving Toward Progress

Dr. Bressler says physicians and patients need to become more aware of the vision risks involved in diabetes. “We need to develop strategies to increase awareness, especially given the recent availability of improved therapies for DME. Physicians should insist that their patients with diabetes undergo yearly visits to assess vision and the retina. Everyone with diabetes should be referred to specialists who can evaluate the retina for DME or other features of diabetic retinopathy, even in the absence of symptoms and when vision is perfect. These visits should occur periodically so that any signs of complications can be treated to prevent vision impairment and blindness.”