From the Guidelines
Macular edema can occur in any stage of diabetic retinopathy (DR), from mild nonproliferative diabetic retinopathy (NPDR) through proliferative diabetic retinopathy (PDR). While it is more commonly associated with more advanced stages of DR, it can develop even in the early stages. Diabetic macular edema (DME) results from the breakdown of the blood-retinal barrier, allowing fluid to accumulate in the macula, the central part of the retina responsible for detailed vision. This occurs due to increased vascular permeability caused by elevated levels of vascular endothelial growth factor (VEGF) and inflammatory mediators in diabetic patients.
Key Points
- Treatment options for DME include anti-VEGF injections (such as ranibizumab, aflibercept, or bevacizumab), corticosteroid injections, and focal laser photocoagulation 1.
- The presence of macular edema significantly impacts visual prognosis regardless of the DR stage, making it important to monitor for DME at every stage of diabetic retinopathy through regular comprehensive eye examinations 1.
- Promptly refer individuals with any level of diabetic macular edema, moderate or worse nonproliferative diabetic retinopathy (a precursor of proliferative diabetic retinopathy [PDR]), or any PDR to an ophthalmologist who is knowledgeable and experienced in the management of diabetic retinopathy 1.
- Panretinal laser photocoagulation therapy is indicated to reduce the risk of vision loss in individuals with high-risk PDR and, in some cases, severe nonproliferative diabetic retinopathy 1.
- Intravitreous injections of anti–vascular endothelial growth factor (anti-VEGF) are a reasonable alternative to traditional panretinal laser photocoagulation for some individuals with PDR and also reduce the risk of vision loss in these individuals 1.
Stages of DR that can have Macular Edema
- Mild nonproliferative diabetic retinopathy (NPDR)
- Moderate nonproliferative diabetic retinopathy (NPDR)
- Severe nonproliferative diabetic retinopathy (NPDR)
- Proliferative diabetic retinopathy (PDR) According to the most recent study 1, macular edema can occur at any stage of diabetic retinopathy, and treatment should be tailored to the individual patient's needs.
From the Research
Stages of Diabetic Retinopathy with Macular Edema
The following stages of diabetic retinopathy (DR) can have macular edema:
- Non-proliferative diabetic retinopathy (NPDR) 2, 3
- Proliferative diabetic retinopathy (PDR) 4, 5, 6, 3
Characteristics of Macular Edema in DR
Macular edema in DR is associated with:
- Increased levels of inflammatory and pro-angiogenic factors in the ocular compartment 6
- Microvascular occlusions and vascular hyperpermeability 6
- Potential sight-threatening disease if not treated correctly 4
Treatment Options for Macular Edema in DR
Treatment options for macular edema in DR include: