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Diabetic Macular Edema

Disease Details

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Description: Diabetic macular edema is a complication of diabetes where fluid accumulates in the macula, leading to vision impairment or loss.
Type: Diabetic macular edema (DME) is not typically classified under a specific type of genetic transmission. Instead, it is primarily a complication of diabetes mellitus (type 1 or type 2), which results from a combination of genetic predisposition and environmental factors. While there is a genetic component to the risk of developing diabetes, and consequently DME, the condition itself is not inherited in a straightforward Mendelian pattern.
Signs And Symptoms: Nearly all people with diabetes develop some degree of retina damage ("retinopathy") over several decades with the disease. For many, that damage can only be detected by a retinal exam, and has no noticeable effect on vision. Over time, progressive retinal damage may appear on a retinal exam, first with small bulges in retinal blood vessels called microaneurysms. Then larger abnormalities in retinal vessels: cotton wool spots, hemorrhages, lipid deposits called "hard exudates", intraretinal microvascular abnormalities, and abnormal-looking retinal veins. Eventually, many progress to a stage where new blood vessels grow throughout the retina. These new blood vessels often break and bleed. Minor bleeding can cause dark floating spots obstructing vision; major bleeding can completely block vision.Around half of people with diabetic retinopathy develop swelling of the macula, called macular edema, which can begin at any time. If the swelling occurs near the center of the macula, it can cause vision disruptions ranging from mildly blurred vision to severe loss of the center of an affected person's visual field. Left untreated, around 30% of those with such swelling experience vision disruption over the next 3–5 years. Macular edema is the most common cause of vision loss in people with diabetic retinopathy.The repeated processes of blood vessel growth, swelling, and scarring can eventually cause retinal detachment, which manifests as the sudden appearance of dark floating spots, flashes of light, or blurred vision.
Prognosis: Diabetic macular edema (DME) is a condition that affects the eyes of individuals with diabetes, leading to vision impairment.

Prognosis: The long-term outlook for individuals with DME can vary depending on several factors, including the severity of the condition at the time of diagnosis, the effectiveness of treatment, and the overall control of diabetes. Early detection and treatment are crucial. Modern therapies, such as anti-VEGF injections, corticosteroids, and laser photocoagulation, have significantly improved the prognosis for many patients, helping to stabilize or even improve vision. However, if left untreated, DME can lead to severe vision loss or even blindness. Regular monitoring and management of blood glucose, blood pressure, and lipid levels are essential to prevent progression.
Onset: Diabetic macular edema (DME) is a complication of diabetes that can develop at any stage of diabetic retinopathy. It typically manifests after several years of poorly controlled blood sugar levels but can vary from person to person. The condition arises when blood vessels in the retina leak fluid, causing the macula to swell and impair vision. Early detection through regular eye exams is crucial for managing DME effectively.
Prevalence: Diabetic macular edema (DME) affects approximately 7.5% of individuals with diabetes, making it a common complication of diabetic retinopathy and a leading cause of vision loss in diabetic patients.
Epidemiology: Around 35% of people with diabetes have some kind of diabetic retinopathy; around 10% experience some degree of vision loss. Diabetic retinopathy is particularly common in those with type 1 diabetes – affecting 25% of people five years from diagnosis, 60% 10 years from diagnosis, and 80% 15 years from diagnosis. Chances of disease progression are heavily influenced by blood sugar control, but on average 7% of those with diabetes experiencing proliferative diabetic retinopathy and 7% diabetic macular edema. Diabetic retinopathy is the leading cause of vision loss in those 20–74 years old.The global burden of diabetic retinopathy increased dramatically from 1990 to 2015—from 1.4 million to 2.6 million people with visual impairment; from 0.2 million to 0.4 million blinded—due in large part to the increasing burden of type 2 diabetes in low- and middle-income countries.
Intractability: Diabetic macular edema (DME) is not considered intractable. While it can be challenging to manage, various effective treatments are available. These include anti-VEGF (vascular endothelial growth factor) injections, corticosteroids, and laser therapy. The response to treatment can vary, and ongoing management and monitoring are often necessary to control the condition and preserve vision.
Disease Severity: Diabetic macular edema (DME) is a complication of diabetes that affects the macula, part of the retina responsible for central vision.

**Disease Severity:**
1. **Mild DME**: Some retinal thickening or hard exudates in the macula area but not involving the fovea (the center of the macula).
2. **Moderate DME**: Retinal thickening or hard exudates approaching the fovea.
3. **Severe DME**: Significant retinal thickening involving the fovea, leading to central vision impairment.

Severity is usually assessed through clinical examination, optical coherence tomography (OCT), and fluorescein angiography. Timely identification and management are crucial to prevent vision loss.
Healthcare Professionals: Disease Ontology ID - DOID:9191
Pathophysiology: Diabetic macular edema (DME) is a condition where fluid accumulates in the macula, the central part of the retina, due to leaking blood vessels. It occurs as a complication of diabetic retinopathy, which affects the blood vessels in the retina due to chronic high blood sugar levels. The pathophysiology involves the breakdown of the blood-retinal barrier, increased vascular permeability, and leakage of fluid into the retinal tissue, leading to swelling and thickening of the macula, impairing central vision.
Carrier Status: Diabetic macular edema (DME) is not a condition that has a carrier status, as it is not inherited in a manner similar to genetic conditions where a carrier status typically applies. Instead, DME is a complication of diabetes mellitus, particularly associated with prolonged high blood sugar levels, which leads to damage to the blood vessels in the retina, causing them to leak fluid and leading to swelling in the macula.
Mechanism: Diabetic macular edema (DME) is a condition where fluid accumulates in the macula, the central part of the retina, leading to vision impairment or loss. This condition primarily occurs due to diabetes-related damage to the retinal blood vessels, resulting in increased vascular permeability.

**Mechanism:**
The mechanism of DME involves the breakdown of the blood-retinal barrier, which allows fluid to leak into the macula. This leakage is primarily due to the weakening of the retinal blood vessels caused by prolonged high blood sugar levels in diabetics.

**Molecular Mechanisms:**
1. **Hyperglycemia-Induced Oxidative Stress:** Chronic high blood sugar levels lead to the overproduction of reactive oxygen species (ROS) within retinal cells, resulting in oxidative stress. This damages the retinal blood vessels and contributes to increased vascular permeability.

2. **Inflammatory Pathways:** Hyperglycemia triggers the activation of various inflammatory cytokines and chemokines including vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α), and interleukins. VEGF, in particular, plays a pivotal role by increasing the permeability of retinal blood vessels and promoting the formation of new, fragile blood vessels which are prone to leakage.

3. **Protein Kinase C (PKC) Activation:** Elevated glucose levels activate the protein kinase C (PKC) pathway, specifically isoforms like PKC-β, which contribute to increased retinal capillary permeability and reduced blood flow, exacerbating the leakage of fluid into the macula.

4. **Advanced Glycation End-products (AGEs):** Hyperglycemia leads to the formation and accumulation of AGEs which can cross-link with proteins and other molecules, altering their function. AGEs can also bind to their receptors (RAGE) on retinal cells, resulting in inflammation, oxidative stress, and vascular leakage.

5. **Breakdown of the Blood-Retinal Barrier (BRB):** The integrity of the BRB is compromised due to the aforementioned factors, leading to the extravasation of plasma constituents into the macular interstitium.

These molecular alterations collectively contribute to the pathogenesis of diabetic macular edema, making it a significant complication of diabetes mellitus that requires medical attention and management.
Treatment: Diabetic macular edema (DME) is treated through several approaches, including:

1. **Anti-VEGF Injections:** Medications like ranibizumab, aflibercept, or bevacizumab are injected into the eye to reduce fluid leakage and swelling.

2. **Corticosteroids:** Steroid injections or implants (e.g., dexamethasone implant) can help reduce inflammation and edema.

3. **Laser Therapy:** Focal/grid laser photocoagulation can be used to seal leaking blood vessels and reduce fluid accumulation.

4. **Control of Blood Sugar Levels:** Tight glycemic control through diet, exercise, and medication helps prevent further damage.

5. **Blood Pressure and Cholesterol Management:** Controlling hypertension and hyperlipidemia can also slow the progression.

Regular monitoring and early detection are crucial for effective management.
Compassionate Use Treatment: For diabetic macular edema (DME), several compassionate use treatments, off-label, or experimental treatments may be considered:

1. **Compassionate Use Treatments**: These involve treatments not yet approved by regulatory authorities but made available to patients with serious conditions when no comparable or satisfactory alternative therapies exist. Examples include investigational drugs showing promise in clinical trials.

2. **Off-Label Treatments**:
- **Corticosteroids**: Intravitreal injections of steroids like triamcinolone acetonide are sometimes used off-label to reduce inflammation and edema.
- **Anti-VEGF Agents**: While drugs like bevacizumab (Avastin) are FDA-approved for other indications, they are often used off-label for DME due to their anti-angiogenic properties.

3. **Experimental Treatments**:
- **Gene Therapy**: Experimental studies are investigating gene therapy approaches to treat or prevent DME.
- **Novel Small Molecules**: Research into new small molecule inhibitors that target pathways involved in DME is ongoing.
- **Stem Cell Therapy**: Early-phase trials are exploring the potential of stem cells to repair or regenerate retinal tissue.

Patients should consult with their healthcare providers to discuss the potential risks and benefits of these treatments.
Lifestyle Recommendations: For diabetic macular edema (DME), here are some lifestyle recommendations:

1. **Blood Sugar Control**: Maintain your blood sugar levels within the target range to prevent further damage to retinal blood vessels.
2. **Diet**: Adopt a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit high-sugar and high-fat foods.
3. **Exercise**: Engage in regular physical activity, such as walking, swimming, or yoga, to help manage blood sugar levels and overall health.
4. **Blood Pressure and Cholesterol**: Keep blood pressure and cholesterol levels under control through diet, exercise, and medications if needed.
5. **Smoking Cessation**: Quit smoking as it can exacerbate retinal damage and other complications.
6. **Regular Eye Exams**: Schedule frequent eye check-ups to monitor the condition and catch any changes early.
7. **Weight Management**: Maintain a healthy weight to improve blood sugar control and reduce the risk of complications.

These lifestyle choices can help manage and potentially slow the progression of diabetic macular edema.
Medication: Medications for diabetic macular edema (DME) commonly include anti-VEGF (vascular endothelial growth factor) agents such as:

1. **Ranibizumab (Lucentis)**
2. **Aflibercept (Eylea)**
3. **Bevacizumab (Avastin)** - often used off-label.

In some cases, corticosteroids like **dexamethasone (Ozurdex)** implant or **fluocinolone acetonide (Iluvien)** implant may also be used. Always consult with a healthcare professional for appropriate diagnosis and treatment.
Repurposable Drugs: Repurposable drugs for diabetic macular edema (DME) include:

1. **Dexamethasone** - A corticosteroid that can reduce inflammation and edema.
2. **Aflibercept** - Originally developed for different conditions, this VEGF inhibitor is effective in DME.
3. **Ranibizumab** - Another VEGF inhibitor initially used for age-related macular degeneration, also used in DME.
4. **Bevacizumab** - Primarily used for cancer treatment, it's used off-label for DME.

Please consult with a healthcare provider for personalized medical advice.
Metabolites: Diabetic macular edema (DME) is associated with various metabolic changes in the eye. Abnormal glucose metabolism in diabetes leads to increased levels of advanced glycation end products (AGEs), oxidative stress, and inflammation, contributing to vascular permeability and fluid accumulation in the macula. Key metabolites involved in DME include glucose, sorbitol, and fructose. These metabolites can disrupt normal cellular function, leading to macular thickening and vision loss.
Nutraceuticals: There is no strong clinical evidence to support the use of nutraceuticals specifically for the treatment of diabetic macular edema (DME). Standard treatments typically include anti-VEGF injections, corticosteroids, and laser therapy. While some nutraceuticals like antioxidants, omega-3 fatty acids, and vitamins may have general benefits for eye health and diabetes management, their direct impact on DME has not been well-established through rigorous clinical trials. Always consult with a healthcare provider before starting any new supplement regimen.
Peptides: Peptides are short chains of amino acids that can play various roles in the body, including acting as signaling molecules or having therapeutic effects. In the context of diabetic macular edema (DME), research is exploring the use of specific peptides that might help reduce inflammation, inhibit abnormal blood vessel growth, or protect retinal cells from damage.

Nanotherapeutics involve the use of nanoscale materials and technologies for medical treatment. In DME, nanotechnology can be used to develop advanced drug delivery systems that target the retina more effectively. Nanoparticles can be engineered to deliver anti-inflammatory or anti-VEGF (vascular endothelial growth factor) drugs directly to the site of edema, potentially enhancing treatment efficacy and reducing side effects.