Macular Edema in Diabetes Clinical Presentation

  • Author: Emmanouil Mavrikakis, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 7, 2012
 

History

Specific inquiry should be made into risk factors for the development of diabetic retinopathy. These include the type of diabetes, the duration, and the degree of control. After 20 years of disease, nearly all patients with type 1 and 60% of patients with type 2 diabetes have some degree of retinopathy. The risk increases with the duration of disease. Hence, diabetic retinopathy is more likely to be present in patients older than 40 years.

The Diabetes Control and Complications Trial (DCCT) clearly demonstrated that tighter control of blood sugar is associated with reduced incidence of diabetic retinopathy. Glycosylated hemoglobin [HbA1c] should be less than 7%.

Proteinuria is a good marker for the development of diabetic retinopathy; thus, patients with diabetic nephropathy should be observed more closely. Elevated blood pressure increases the risk of retinopathy; patients with diabetes and hypertension may develop diabetic retinopathy with superimposed hypertensive retinopathy. Elevated triglyceride and lipid levels increase the risk of retinopathy, while normalization of lipid levels reduces retinal leakage and deposition of exudates.

Finally, diabetic retinopathy can progress rapidly in pregnant women, especially those with preexisting diabetic retinopathy.

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Physical Examination

Funduscopy under stereopsis and high magnification should be performed on every patient with diabetes to assess for diabetic macular edema and diabetic retinopathy. An indirect ophthalmoscope does not provide adequate magnification for the diagnosis of diabetic macular edema.

Diabetic macular edema is defined as retinal thickening within 2 disc diameters of the center of the macula. Focal edema is associated with hard exudate rings resulting from leakage from microaneurysms. Diffuse edema results from breakdown of the blood-retinal barrier with leakage from microaneurysms, retinal capillaries, and arterioles.

Clinically significant macular edema (CSME), as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS), exists with any of the following findings:

  • Retinal thickening within 500 µm of the center of the fovea
  • Hard, yellow exudates within 500 µm of the center of the fovea with adjacent retinal thickening
  • At least 1 disc area of retinal thickening, any part of which is within 1 disc diameter of the center of the fovea

Visual acuity should also be measured. Although visual acuity does not aid in the diagnosis of CSME—initially, at least, patients may have a visual acuity of 20/20—it is an important parameter in following the progression of CSME.

The status of the posterior hyaloid should also be determined. In CSME, the posterior hyaloid is detached, taut, and thickened.

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Contributor Information and Disclosures
Author

Emmanouil Mavrikakis, MD, PhD  Consultant Vitreoretinal Surgeon, Ophthalmology Department, Athens Medical Centre, Greece

Emmanouil Mavrikakis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Coauthor(s)

Baseer U Khan, MD  Staff Physician, Department of Ophthalmology, University of Toronto, Canada

Baseer U Khan, MD is a member of the following medical societies: Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

Wai-Ching Lam, MD, FRCS(C)  Professor, Department of Ophthalmology and Vision Sciences, University of Toronto

Wai-Ching Lam, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, Canadian Ophthalmological Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Novartis Honoraria Speaking and teaching; Novartis Honoraria Review panel membership; Allergan Honoraria Review panel membership; Alcon Honoraria Speaking and teaching

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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