Approach Considerations

Diagnosis of diabetic macular edema (DME) 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 demonstrates a moderate correlation between retinal thickness and best-corrected visual acuity, and it has been able to demonstrate three basic structural changes of the retina from diabetic macular edema: retinal swelling, cystoid edema, and serous retinal detachment.

OCT is not required to establish a diagnosis, and it is not prescribed by current practice guidelines; however, OCT has gained widespread acceptance as an additional modality to help identify and evaluate macular pathology.^[5]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 it 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. Note the proximity of the leakage to the foveal avascular zone.

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

Treatment & Management

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Author

Emmanouil Mavrikakis, MD, PhD Ophthalmologist-in-Chief, Consultant Vitreoretinal Surgeon, Ophthalmology Department, G Gennimatas Athens General Hospital, Greece

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

Disclosure: Nothing to disclose.

Coauthor(s)

Baseer U Khan, MD Associate Professor of Ophthalmology, University of Toronto Faculty of Medicine; Ophthalmologist, Clarity Eye Institute, Canada

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

Disclosure: Nothing to disclose.

Wai-Ching Lam, MD, FRCSC Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine, Canada

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

Disclosure: Received honoraria from Novartis for speaking and teaching; Received honoraria from Allergan for review panel membership; Received honoraria from Alcon for review panel membership; Received honoraria from Bayer for consulting; Received honoraria from Alcon for review panel membership; Received honoraria from Novartis for review panel membership.

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: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Macular Edema in Diabetes Workup

Approach Considerations

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