Eye Health | Mount Sinai Today

How Can I Protect My Eyes From Diabetic Macular Edema?

Updated on Nov 6, 2024 | Diabetes, Eye Health, Ophthalmology, Your Health

Beyond causing elevated levels of blood sugar, diabetes can cause other serious complications, including poor vision or blindness. The leading cause of blindness in the working population in the United States, diabetic macular edema (DME) can cause an inability to read, drive, and perform daily activities. According to the Centers for Disease Control and Prevention, diabetic macular edema can affect up to 28 percent of people diagnosed with diabetes.

Nazanin Barzideh, MD, FACS, FASRS

In this Q&A, Nazanin Barzideh, MD, FACS, FASRS, ophthalmologist and retina specialist at New York Eye and Ear Infirmary of Mount Sinai at Mount Sinai Doctors-Carle Place, and Assistant Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, explains what diabetic macular edema is, signs and symptoms to look out for, and why it’s important to get diagnosed and be treated early.

What is Diabetic Macular Edema?

DME is the most common cause of vision loss in people with diabetic retinopathy. Diabetic macular edema is due to leakage of fluid and accumulation in the macula (or the central area that is responsible for fine detail vision) from vascular damage due to diabetic damage. As fluid collects in this nerve tissue, it causes swelling and disrupts anatomy of the fovea. The macula is the central part in the retina that is in the back of the eye and where vision is the sharpest. Typically, vision loss from DME develops over time as the disease becomes more advanced, and makes it impossible to focus clearly.

What are signs of DME?

It’s important to know that DME may cause a spectrum of changes from mild blurry vision to significant vision loss, and it can affect daily functions such as reading, writing, and driving.

Some common symptoms include:

Blurry or distorted vision
Blind spots
Squinting
Double vision
Floaters
Colors appear dull or grayish
Difficulty reading, driving, or doing other activities
Difficulty seeing when there is bright light or a glare
Trouble with recognizing faces or objects

How is DME diagnosed?

Diagnostic tests ensure an accurate assessment of DME and may include the following:

Comprehensive dilated eye exam.
Fluorescein angiography (FA): A diagnostic imaging technique where a dye is injected to identify abnormalities in the retinal blood vessels.
Optical coherence tomography (OCT): A non-invasive imaging technique that shows cross-sectional images of the retina, helping to detect inflammation and fluid accumulation in the macula.
Optic coherence tomography angiogram (OCTA): A non-invasive imaging technique that maps out and identifies retinal vascular abnormalities without using a dye.

Why is it important to get diagnosed and treated early?

Early detection of and prompt intervention in DME are essential to preserve vision in diabetic patients. The sooner a diagnosis can be made, the sooner a personalized treatment plan can be put in place to take care of the eyes and manage DME so it doesn’t progress to more advanced stages.

It’s also important to understand that eye conditions related to diabetes like retinopathy and macular edema are impacted by the longevity of the elevated blood sugar levels. The highs and lows through time really affect long-term prognosis, which is why it’s critical to control glucose levels from the day of diagnosis and to maintain that control throughout the years.

How is DME treated?

Control blood sugar levels on a regular basis.
Eye drops in some cases.
Anti-VEGF, a group of medications known as vascular endothelial growth factor treatments, that block the hormone VEGF, which can cause abnormal blood vessel growth in the eyes. They are injected directly into the back of the eye.
Corticosteroids that reduce inflammation and fluid leakage, and help to improve and sustain vision and slow down the disease progression.
Laser therapy where a focused laser beam is used to seal blood vessels in the eyes to stop fluid leakage that leads to DME.

How can we prevent DME and protect vision?

Get a comprehensive dilated eye exam yearly at minimum, or as directed by your ophthalmologist or retina specialist.
Control diabetes and maintain good blood sugar, blood pressure, and cholesterol levels, monitoring them regularly.
Manage other conditions associated with diabetes like heart disease, kidney disease, and obesity, for example.
Stay active, exercise regularly, eat healthily, drink plenty of water, and maintain a healthy lifestyle.

Please call 516-408-4900 to schedule an appointment.

Learn more about our ophthalmology services at New York Eye and Ear Infirmary of Mount Sinai-Carle Place (Long Island)

Learn more about New York Eye and Ear Infirmary of Mount Sinai

Going Blind In One Eye? You May Be Having an Eye Stroke

Updated on Jun 30, 2022 | Eye Health, Your Health

Sudden vision loss in one eye may be a sign of Central Retinal Artery Occlusion (CRAO), commonly referred to as eye stroke. Like a stroke in the brain, it is a medical emergency and must be diagnosed and treated as quickly as possible to prevent irreversible loss of vision.

It is estimated that about 12,000 people suffer an eye stroke every year. Risk factors include smoking, cardiovascular disease, diabetes, high cholesterol, high blood pressure, and narrowing of the carotid or neck arteries, but it can affect anyone, particularly those over 60 years of age.

In this Q&A, Richard B. Rosen, MD, Chief of Retina Service at Mount Sinai Health System and Vice Chair and Director of Ophthalmology Research at the New York Eye and Ear Infirmary of Mount Sinai (NYEE), explains Mount Sinai’s unique approach in this area, and how getting to a hospital as soon as possible can help doctors diagnose your problem and restore your vision.

“Eye stroke must be addressed immediately to prevent permanent vision loss. If you wake up with vision loss, get to the emergency room as quickly as possible, don’t put it off until after breakfast,” says Dr. Rosen, who is also Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai. “That will enable doctors at Mount Sinai to restore your vision if it’s an eye stroke and, if it’s something else, we can send you to an ophthalmologist. Not all hospital emergency departments have the specialized equipment and procedures we have in place to ensure patients get treatment in an expedited fashion.”

What is an eye stroke?

Blood vessels supply oxygen and nutrients to the retina, the light-sensitive tissue in the back of the eye. The retina transfers visual signals to the brain, which enable us to see images clearly. If an artery is blocked, it can deprive the retina of oxygen and can cause the retinal nerve cells to die unless blood flow is quickly restored.

What are the symptoms?

There are four key symptoms of eye stroke. They are:

Severe blurring or complete loss of vision may occur suddenly, and almost always only in one eye. It is often described as a curtain crossing over the vision, or it may appear totally black or white.
An eye stroke is painless, which often makes it different from other causes of vision loss.
Blurring may worsen over a few minutes and sometimes improve suddenly.
Painless vision loss may also be a sign of a stroke in the brain, and patients experiencing eye stroke are at risk for brain stroke.

Why is it so important to act quickly?

Anyone experiencing these symptoms must get immediate medical treatment, even if symptoms seem to improve. Even temporary vision loss might indicate an increased risk of stroke or future vision loss. The Emergency Departments at several Mount Sinai hospitals are equipped to diagnose (or rule out) and treat eye stroke quickly: NYEE, The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Queens. Treatment must be administered within 6-12 hours (ideally in less than six hours) to prevent irreversible vision loss. A team of Mount Sinai retina specialists is available 24/7 to make a diagnosis using non-invasive imaging. If a retinal artery occlusion is not the cause, doctors can address your problem or connect you with the appropriate eye doctor.

How is eye stroke treated?

To dissolve the clot, an interventional radiologist administers an injection of tissue plasminogen activator (tPA), a clot-busting drug, directly into the blocked artery. There is a small window to intervene. To prevent permanent blindness, blood flow to the retina must be restored within six to 12 hours, and the sooner blood flow can be restored the more vision can be saved. TPA represents the latest advancement in eye stroke treatment, an area that NYEE has been actively researching.

How do doctors at Mount Sinai diagnose eye stroke?

NYEE, part of Mount Sinai Health System, has developed an eye stroke protocol, working with the Mount Sinai Stroke Center, that combines the expertise of ophthalmologists, neuroradiologists, neurologists, and emergency department faculty. Trained staff are available 24/7 to take images of the eye. The images are sent to one of NYEE’s retina specialists to make a rapid diagnosis. If an eye stroke is confirmed, the Mount Sinai Stroke Service begins treatment immediately to save the patient’s sight.

Mount Sinai doctors accurately diagnose eye stroke using advanced optical coherence tomography (OCT) systems, a technology that most hospitals do not have available at the point of care. The non-invasive system detects swelling by using infrared light to produce digital images of the retina at very high resolution. Using this system, what might take one or two hours in some facilities, can now be done in about 15 minutes at Mount Sinai, thereby saving valuable time.

Make an appointment with Dr. Rosen