From the Guidelines
Macular edema is best diagnosed using Optical Coherence Tomography (OCT) imaging, which provides high-resolution imaging of the macula and detects the presence and extent of any associated macular edema, vitreoretinal interface changes, and subretinal fluid. A comprehensive eye examination by an ophthalmologist or retina specialist is essential, starting with a dilated eye exam to examine the retina and macula.
Diagnostic Process
The diagnostic process for macular edema involves several steps, including:
- A dilated eye exam to examine the retina and macula
- Optical Coherence Tomography (OCT) imaging to detect fluid accumulation and measure retinal thickness 1
- Slit-lamp biomicroscopy to evaluate retinopathy of the posterior pole and midperipheral retina
- Examination of the peripheral retina and vitreous using indirect ophthalmoscopy
- Fundus photography to document the severity of retinal findings and response to treatment
Importance of OCT
OCT is a crucial diagnostic tool for macular edema, as it provides detailed cross-sectional images of the retina and can detect microstructural changes secondary to ischemia 1. The use of OCT has become increasingly important in the diagnosis and treatment of macular edema, particularly with the use of anti-VEGF agents and intraocular corticosteroids.
Additional Tests
Additional tests that may be performed to diagnose macular edema include:
- Fluorescein angiography to identify leaking vessels that cause edema
- Visual acuity assessment using an eye chart
- Amsler grid testing to detect central vision distortions
- Gonioscopy to assess the anterior chamber angle
Underlying Causes
Identifying the underlying cause of macular edema is essential, as it can occur secondary to other diseases like diabetic retinopathy, retinal vein occlusion, or uveitis 1. A comprehensive diagnostic approach is necessary to determine the underlying cause and develop an effective treatment plan.
From the Research
Diagnosis of Macula Edema
To diagnose macula edema, several methods can be employed, including:
- Spectral domain optical coherence tomography (SD-OCT) to quantify diabetic macular edema (DME) and assess central subfield thickness 2
- Visual acuity testing to evaluate the impact of macula edema on vision
- Slit-lamp biomicroscopy and dilated fundus examination to visually inspect the retina for signs of edema
- Digital fluorescence angiography to examine the retinal vasculature and detect any abnormalities
Imaging Techniques
Imaging techniques play a crucial role in diagnosing and monitoring macula edema, including:
- SD-OCT to measure retinal thickness and detect cystoid macular edema (CME) 3
- Optical coherence tomography angiography (OCTA) to evaluate vessel metrics and predict disease progression 4
- Anterior segment optical coherence tomography (AS-OCT) and AS-OCTA to examine the anterior segment of the eye 5
Clinical Features
Clinical features of macula edema may include:
- Reduced visual acuity
- Cystoid macular edema (CME)
- Epiretinal membrane (ERM)
- Outer retinal corrugation, which can predict poor visual acuity outcome 3
- Diabetic retinopathy, which can increase the risk of macula edema 4, 6
Diagnostic Criteria
Diagnostic criteria for macula edema may include:
- Central subfield thickness exceeding 300 microns on SD-OCT
- Presence of CME or other retinal abnormalities on SD-OCT or OCTA
- Reduced visual acuity or other visual disturbances
- Clinical features such as ERM or outer retinal corrugation 3