Definition – Macular Edema
Macular edema is an accumulation of fluid in the area of the macula. The macula is also called the “yellow spot” and is the area of sharpest vision on the retina of the human eye. It is in the macula that the density of sensory receptors that enable vision is at its highest, giving us a sharp overall image.
Macular edema can significantly impair the vision of the affected eye, as the accumulated fluid causes swelling of the retina. The affected persons are unable to focus objects properly and vision becomes blurred. There are various causes for the development of macular edema.
The ophthalmologist diagnoses the disease and can then initiate the appropriate therapy. Characteristically, macular edema is characterized by a slowly progressing, creeping course. During the course of the disease, sudden vision problems can occur.
These include blurred vision and problems with color vision. In addition, objects can no longer be focused sharply. Occasionally, the affected persons also suffer from loss of vision or a “grey veil” in the field of vision.
Other symptoms include dark spots that hover over the field of vision and impair vision. Double images or a red veil can also occur. Due to the visual impairment, patients are severely restricted in many areas of life.
This considerably reduces the quality of life and increases the risk of developing depression. Especially the diabetic macular edema can be asymptomatic for a long time and the patients have only slight visual problems during the course of the disease. Over time, the disease progresses more and more and the visual acuity decreases more and more.
If diabetic macular edema is not treated in time, there is even a risk of blindness in the affected eye. In case of visual problems and other symptoms that may be due to macular edema, an ophthalmologist should be consulted immediately. The doctor discusses the complaints with the patient and performs various examinations, such as an eye test and a funduscopy or ophthalmoscopy of the back of the eye.
This allows to detect pathological changes in the macula and to make a diagnosis of macular edema. In some cases, a so-called fluorescence angiography can also be performed to show the blood vessels on the retina. The specific treatment of a macular edema depends on the stage of the disease and the cause of the fluid accumulation.
In most cases a laser treatment is used. In this procedure, the ophthalmologist irradiates the affected area on the retina with high-energy laser light, which closes any leaking vessels. The formation of undesirable new blood vessels is also prevented by this treatment.
Another possibility for the treatment of macular edema is the administration of medication. Commonly used drugs are non-steroidal anti-inflammatory drugs (NSAIDs), steroids, VEGF inhibitors or carboanhydrase inhibitors. These substances are either administered in the form of eye drops or injected directly into the eyeball.
In rare cases, systemic treatment in the form of tablets or infusions may also be necessary. Diabetic macular edema is treated by medication applied directly into the eye and laser treatment. Diabetics who are at risk of developing diabetic macular edema must pay particular attention to an optimally adjusted blood sugar level.
Blood pressure should also be checked regularly and reduced if necessary to prevent damage to the retina. Smoking, unhealthy nutrition and overweight are further risk factors that the patient can reduce voluntarily. For certain diseases underlying macular edema, it may be necessary to inject medication directly into the diseased eye.
For this purpose, the ophthalmologist injects preparations containing cortisone or so-called VEGF inhibitors as the active ingredient after a local anaesthetic. The injection is made directly into the vitreous body of the eye. Cortisone is a steroid hormone that has a general anti-inflammatory effect and is used in various diseases.
VEGF inhibitors block the action of a substance produced naturally in the body, which is directly responsible for the formation of new blood vessels. This allows targeted intervention in the cause of macular edema.Homeopathic medications and natural remedies can contribute to the treatment of macular edema. The aim of these alternative treatment methods is to improve the state of health and to strengthen the body’s own self-healing process.
Trained homeopaths are able to assess whether homeopathic treatment is appropriate depending on the cause and form of the macular edema. However, homeopathy should not be used alone in this disease but serves as an accompanying therapeutic measure to conventional medicine, since insufficient treatment can cause severe damage to the optic nerve. A macular edema can have various causes.
Often the disease is caused by an inflammation of the eye, for example retinitis or uveitis. The inflammation makes the blood vessels more permeable and presses fluid into the surrounding tissue. Vascular calcification in the eye or a blood clot (thrombus) in an artery or vein leads to blood congestion and consequently to swelling of the retina.
There is also an increased risk of developing macular edema after eye surgery, for example after cataract surgery. People with high blood pressure (arterial hypertension), elevated blood lipid levels (hyperlipidemia), diabetes mellitus or inflammatory eye diseases have an increased risk of developing macular edema. The chances of recovery from macular edema depend on the type of disease (diabetic or cystic macular edema) and the severity of the symptoms.
In case of complaints, especially in case of altered color vision, a doctor should be consulted immediately, because if not treated there is a risk of permanent visual damage or even blindness. Cystic macular edema, which usually develops as a result of eye surgery, usually has a good prognosis and disappears after a few weeks. Even in the case of RCS, which is caused by stress, the chances of recovery are good.
If the macular edema is caused by diabetic retinopathy, the prognosis is worse. This is due to the fact that the symptoms often only appear when the retina is already clearly damaged. Diabetics should therefore visit an ophthalmologist regularly to detect and treat pathological changes in the eye as early as possible.
Despite appropriate treatment, macular edema can occur repeatedly in some patients (recurrence) and lead to serious damage to the retina. As a consequence, permanent visual impairment and in the worst case even permanent loss of vision in the affected eye can occur. Mental stress and chronic stress can lead to the development of macular edema and visual disorders.
This clinical picture is known as retinopathy centralis serosa (RCS) and often affects young, ambitious men between the ages of 30 and 50. For this reason, RCS is also called “managerial disease”. The exact cause of macular edema is unclear, but fluid leaks from the vessels and the fluid accumulates behind the macula.
Typical symptoms of RCS are a sudden deterioration of vision, distortions and visual field failures. A distinction is made between an acute course, which usually heals spontaneously within a few weeks, and a chronic form. The chronic form should always be treated with laser therapy or medication, otherwise there is a risk of permanent visual impairment.
A cataract operation is a surgical procedure on the eye, which is used in patients with cataracts. An artificial lens is inserted into the eye. Although it is a routine procedure, there is a risk of developing macular edema in rare cases.
Approximately one in a hundred people who have undergone surgery will develop water retention under the retina within a few weeks of surgery. This clinical picture is called cystoid macular edema. To prevent this complication, anti-inflammatory drugs (mostly non-steroidal anti-rheumatic drugs or steroids, possibly a combination of these two drugs) can be injected directly into the eye.
This prophylactic therapy is particularly necessary for high-risk patients, e.g. diabetics. A cystoid macular edema (medically also called CME) often develops after cataract extraction.A CME caused by cataract surgery is called Irvine-Gass syndrome. Other causes for the development of a CME are eye injuries, drug side effects or the occlusion of a retinal vein.
The cystoid macular edema is characterized by the accumulation of small, fluid-filled vesicles in the area of the macula on the retina. Due to the swelling, the central optic nerve is squeezed and visual disturbances occur. It is not clear why cystoid macular edema occurs mainly after cataract surgery.
In most cases the swelling is successfully reduced after treatment with medication (cortisone eye drops or local injections) and the symptoms improve rapidly. Patients suffering from diabetes mellitus (diabetes mellitus) may develop macular edema during the course of their disease. This form is then called diabetic macular edema (DME).
Due to the diabetes, the small blood vessels in the eye become more and more damaged over time and the retina becomes diseased. Doctors call this clinical picture “diabetic retinopathy“. Especially people with too high blood sugar levels are often affected by this disease.
For this reason, optimal blood glucose control is an important factor in reducing the risk of developing diabetic macular edema. The disease of the retina goes unnoticed for a long time. Eventually, there is a significant deterioration of vision, which can lead to blindness.
An eye examination reveals macular edema in addition to other pathological changes in the eye. The accumulation of fluid presses on the optic nerve and thus contributes to the deterioration of vision. The therapy of diabetic macular edema is carried out by means of special medication and laser treatment of the retina.
