Macular Edema in Diabetes Workup

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

Approach Considerations

Diagnosis of diabetic macular edema is made by funduscopic examination. However, other studies can provide valuable information for guiding treatment and for long-term follow-up.

Optical coherence tomography (OCT) captures reflected light from retinal structures to create a cross-sectional image of the retina, which is comparable to histologic sections as seen with a light microscope. OCT has been able to demonstrate a moderate correlation between retinal thickness and best-corrected visual acuity, and it has been able to demonstrate 3 basic structural changes of the retina from diabetic macular edema: retinal swelling, cystoid edema, and serous retinal detachment.

OCT is not currently required to establish a diagnosis and is not prescribed by current practice guidelines; however, OCT has gained widespread acceptance as an additional modality to help identify and evaluate macular pathology.[6] Quantitative measurement of macular thickness and subjective analysis of the foveal architecture allow a precise and reproducible way to monitor macular edema.

Fluorescein angiography does not aid in the diagnosis of clinically significant macular edema (CSME) but should be performed if treatment of CSME is being considered. Fluorescein angiography distinguishes and localizes areas of focal versus diffuse leakage, thereby guiding the placement of laser photocoagulation. The proximity of the leakage to the foveal avascular zone should be noted.

Color stereo fundus photographs provide an opportunity to evaluate long-term changes in the retina.

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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.

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