Retina specialists are often asked by general ophthalmologists or optometrists to treat the eye complications of diabetes.  One of the most common complications is diabetic macular edema or DME.  Retina specialists use clinical examination in the office to determine if the edema (or swelling) is “clinically significant.”  Signs of clinically significant macular edema are blurred vision, trouble seeing during the day, difficulties reading, and (less commonly) eye floaters.

Clinically significant macular edema (CSME) is present if any of the three exam findings are seen by your ophthalmologist.

• Any retinal edema within 500 microns of the center of the fovea (the most central part of your vision)
• Hard exudates (fats) within 500 microns of the center of the fovea if associated with retinal thickening
• Retinal edema greater than one optic nerve disc in size and within one disc diameter of the center of the fovea

My eye doctor found macular edema.  How can I be treated?

Patients with clinically significant macular edema may benefit from eye laser or eye injections.  Common eye injections include Avastin, Lucentis, and Eylea.  Eye injections of steroids can be helpful in some cases.  Steroids are used sparingly as they can cause cataracts and glaucoma over time and with repeated use.  Good control of blood sugars and blood pressure is critical in the treatment of macular edema.

How can I be tested for macular edema?

A dilated eye exam is the most useful test to determine if you have macular edema.  Your retina specialist may take OCT images (showing the retina in cross section) to show the degree of retinal edema and your improvement over time with repeated eye injections.  A fluorescein angiogram (FA) may be helpful to determine the degree and severity of the retinal swelling.

Without treatment, your vision may become blurred over time since macular edema involves the part of the retina responsible for central vision.

If you are interested, here is some additional reading about macular edema from EyeWiki.

If you are diabetic and think you may have diabetic macular edema, call Dr. Stelton today or contact him here.

Retinal vein occlusion is a common eye problem.  A major cause of retinal vein occlusions is arteriolosclerosis or the thickening of the blood vessel walls.  Thickening of the walls of your blood vessels occurs in response to increased blood pressure.  This arteriolosclerosis leads to a compression of the ocular veins which course under the arteries.  This compression leads to partial occlusion of the vein, development of a blood clot, and damage to the blood vessel wall.  When blood cannot drain properly, it leads to bleeding and leakage of fluid from blocked blood vessels.  Oxygen delivery to the retina is reduced and problems such as blurred vision, blind spots, bleeding in the eye, or a painful type of glaucoma can ensue.

What causes a retinal vein occlusion?

Risk factors for retinal vein occlusion include age (your risk increases 10-fold from age 40 to age 65), hypertension, high cholesterol, diabetes, or elevated eye pressure. In the rare cases where retinal vein occlusion is not explained by these factors, lab work must be done to search for other, uncommon medical conditions that lead to an increased tendency for blood to clot.

What does RVO mean?

Ophthalmologists use different terminology to describe retinal vein occlusions, depending on where the blockage in the eye occurred.  A BRVO, or branch retinal vein occlusion, occurs in one of the smaller veins in the eye.   A BRVO may only affect one-quarter or one-half of the retina, leaving other parts of the retina to function normally. In contrast, a CRVO, or central retinal vein occlusion, affects the main venous drainage of the eye.  Typically, a central retinal vein occlusion is more severe than a BRVO, and patients experience worse vision and develop more complications due to the poor blood flow patterns that result due to the blockage of the main drainage of the eye.

What is your ophthalmologist looking for?

When a retinal specialist looks inside your eye, he can see vessels which are wider and curvier than normal.  This finding indicates your vessels may have increased pressure due to an outflow problem which occurs in any vein occlusion.  The doctor will see many hemorrhages occurring within the retinal layers.  In addition, a swollen optic nerve and swelling in the central retina are often found.  Additional testing (e.g. optical coherence tomography and fluorescein angiogram) done by your retinal specialist can further determine the level of retinal swelling and show how the vein occlusion has affected the blood flow to the eye.

Here is a patient who has suffered a branch retinal vein occlusion.