The DME Domino Effect: Why You Shouldn’t Delay Treatment

“When DME is detected early, treatment can often preserve vision and even reverse vision loss,” says Edward Wood, MD, a retina specialist at Austin Retina Associates in Texas. “However, when DME is not detected early, and there have already been chronic changes to the retina, complete visual recovery may not be possible.”

There’s no one reason DME treatment is delayed. Usually, it’s a mix of factors, including:

1. Delay in DME Diagnosis A delayed diagnosis is the most common reason for not starting treatment early on, says Timothy Murray, MD, a retina specialist at Murray Ocular Oncology and Retina in Miami. “This typically only occurs if you haven’t seen someone that specializes in the care of macular edema — a retina specialist.” A person with diabetes may not notice significant vision changes or may delay a DME screening recommended by an ophthalmologist or retina specialist, not realizing the importance of it, he adds. And people might just be overloaded. “Because diabetes is such a complex condition to navigate, it may be overwhelming to prioritize eye care,” says Garvin Davis, MD, a retina specialist at Houston Methodist Eye Associates.
2. Delay in Diabetes Diagnosis About 1 in 5 people with diabetes don’t know they have it, according to Centers for Disease Control and Prevention estimates.

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   A person who isn’t aware they have diabetes will likely not know about any of the complications, including DME. In many cases, it can take years following the onset of high blood sugar for someone to get a diabetes diagnosis.

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    During that time, those high levels of blood sugar may be causing damage to the body.
3. Lack of Adequate Healthcare and Finances Without good health coverage or access to care, it can be very difficult to get diagnosed with and manage diabetes, let alone DME. This is especially true for people of color, who experience higher rates of DME complications than white people. “Diabetes affects Black, Hispanic, Latinx, and Indigenous people disproportionately. And the impact of this diabetic eye disease among patients from these backgrounds is unequal as well,” says Dr. Davis. “Additionally, newer DME treatments aren’t covered by all insurances, and they can be expensive, which leads to disparities in types of available treatment and a delay [in initiating them],” he adds.
4. Anxiety Around Eye Injections Specialists typically treat DME with anti–vascular endothelial growth factor (VEGF) injections into the eye to slow or stop vision loss. Many people are understandably nervous about getting shots in the eye, especially before the first treatment. “The idea of receiving an eye injection can be terrifying,” Dr. Murray acknowledges. “But the reality is that if the injection is done well by a specialty team, it’s really a minor event.”

Fortunately, there are effective treatments for DME, even for people whose eyesight has gotten progressively worse due to a delayed diagnosis. “Treatment for DME has evolved quite a bit over time,” says Davis. The available options include:

• Anti-VEGF Therapy These eye injections may be given as often as once a month or up to every four months, depending on the severity of the DME and type of medication used. Up to 40 percent of people with DME have significantly improved vision after 1 year of anti-VEGF injections, according to one study.

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  And the treatments at least stabilize vision for 9 out of 10 people getting the injections, the American Academy of Ophthalmology found.

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• Steroid Injections While steroids help reduce inflammation, doctors typically try anti-VEGF therapy first. “If we inject a steroid into the eye of a patient that has not had cataract surgery, they will get a progressive cataract,” says Murray. For this reason, steroids are most commonly used in people with DME who have already had cataract surgery.
• Laser Therapy Although lasers used to be a first-line treatment for DME, anti-VEGF therapy has since replaced it. But the treatment is still used in some cases. “Laser therapy may help slow or stop the growth of new blood vessels that could damage vision, but it may leave permanent blind spots in a person’s vision,” says Davis.

Visiting a retina specialist every year for a dilated retinal eye exam is the best way to help spot vision changes and prevent further loss. You should also talk to your doctor about the different DME treatments. “Each treatment has its own benefits and risks, so it is important to work with your doctor to decide which is best for you,” says Davis. Your doctor will tell you about the latest options, including those that may let you wait longer between treatments.

“People diagnosed with DME should remember that they are not alone. Approximately 750,000 Americans have DME,” says Davis. “Taking action by scheduling an appointment with a retina specialist to discuss treatment options can be empowering, which may also reduce mental and emotional stress.”

In addition to working with your regular care teams, there are many support groups and national organizations that can help you understand DME and live better with the condition, says Dr. Wood, including:

• American Optometric Association Their Find a Doctor of Optometry tool “can help you find low-vision rehabilitation to continue working, plus detailed info on low vision itself,” says Wood.
• The Vision Council Foundation They provide info about low vision and offer a way to search for a low-vision specialist in the United States by ZIP code or address.
• VisionService Alliance They list helpful resources and vision loss info to help guide you personally and professionally, says Wood.

If you suspect there’s something going on with your eyes, get them checked out as soon as possible. Treating DME early is key. And so is sticking to your treatment plan. “With regular treatment, you’re going to be able to drive and read. Many of our patients keep 20/20 vision,” says Murray.

• Ignoring vision symptoms and delaying DME treatment can severely affect your vision.
• Early diagnosis and treatment can help preserve — and possibly even improve — eyesight.
• If you have diabetes, make it a point to schedule a yearly eye exam, and discuss any changes in vision with your eye doctor right away.