Macular Edema in Diabetes Workup

Updated: Aug 28, 2023
  • Author: Emmanouil Mavrikakis, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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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.