Macular edema is an accumulation of fluid in the human eye. The accumulation of fluid, the edema, is located in the area of the yellow spot. This leads to visual disturbances and in particular to blurred vision.
What is macular edema?
According to Etaizhou, macular edema causes swelling of the retina. The tissue swells, especially in the area of the macula. The macula is a small area in the center of the retina. Since most of the visual cells are located here, the macula is the place of sharpest vision. Part of the light that falls on an object is reflected and then enters the eye. The light is focused by the cornea and the lens. The light falls on the center of the retina, on the macula.
Here are numerous light-sensitive sensory cells, so-called photoreceptors. The sensory cells convert the incoming light signals into electrical signals. These electrical signals are then transmitted to the brain via the optic nerve. This then combines the signals from the eye into a finished image.
In the case of macular edema, there is a circumscribed swelling under or in the so-called pigment epithelium of the retina and bubble-like accumulations of water. There are four stages of macular edema. There is focal, clinically significant, diffuse and ischemic macular edema.
There are many causes of macular edema. Retinitis or uveitis can cause swelling of the macula. Retinitis is inflammation of the retina, usually caused by infection with certain bacteria or viruses. Borrelia, Toxoplasma gondii or the cytomegalovirus are possible triggers of retinitis.
Certain hereditary diseases can also lead to retinal inflammation. In uveitis, the middle part of the eye (uvea) is inflamed. Another common cause of macular edema is vascular damage to the retina caused by diabetes mellitus. This is referred to as diabetic retinopathy. The increased sugar levels in diabetes mellitus damage the small blood vessels in particular, such as the capillaries in the retina. This leads to swelling in the area of the retina and thus to damage to the retina.
This damage often goes unnoticed at first. However, diabetic retinopathy is the leading cause of blindness in Europe. Clogging of the veins in the retina can also lead to congestion and macular edema. Such a retinal vein occlusion occurs when a blood clot (thrombus) forms in the vessel or is washed in from another vessel. Arterial hypertension is a risk factor for the development of a retinal vein occlusion. Diabetes mellitus or certain forms of glaucoma also increase the risk of thrombi forming in the blood vessels.
Symptoms, Ailments & Signs
Macular edema usually develops gradually and remains asymptomatic for a long time. In the case of smaller deposits, those affected experience problems in perceiving contrasts or colors. In this phase, however, patients can usually still see clearly without any problems. Reduced visual acuity can only occur in advanced macular edema.
Since the point of sharpest vision is affected in macular edema, the visual disturbances also tend to occur in the central area of the field of vision. Those affected then complain of fuzzy, blurry or distorted vision. Altered color perception can also occur. There may also be dark spots or red veils in the field of vision. Some patients also report a kind of gray curtain in the field of vision.
Even with the first noticeable signs, there is a risk that the disease will progress to blindness. Symptoms interfere with many activities of daily living. This can lead to problems with reading, watching TV or driving a car.
Diagnosis & course of disease
At the beginning of the diagnosis there is always a detailed anamnesis by the ophthalmologist. The existing symptoms and the course of the disease over time are discussed here. The doctor will also ask about previous illnesses, such as high blood pressure or diabetes mellitus. Using various examination techniques, the doctor is able to perceive pathological changes in the eye and thus make a diagnosis.
With simple eye tests, the ophthalmologist can also examine visual acuity and contrast and color perception. With a special ophthalmoscope, he can also take a close look at the fundus of the eye and thus also the patient’s retina. In the case of macular edema, typical deposits, vascular changes or even bleeding are visible here. Such an ophthalmoscope is also referred to as a fundoscopy or ophthalmoscopy and is part of every detailed examination by the ophthalmologist.
In addition to the funduscopy, a so-called fluorescence angiography is often performed. The retinal vessels are made visible with the help of a special dye and a special camera. With optical coherence tomography, the ophthalmologist can also display the individual layers of the retina. This allows fluid retention to be detected early.
Macular edema usually causes problems in the eyes. Visual disturbances develop and those affected can usually no longer see clearly. Double vision or blurred vision can also occur. The quality of life of the patient is significantly restricted and reduced by the macular edema.
It is not uncommon for sudden visual problems to lead to depression or other psychological limitations. Furthermore, the disease can negatively affect the perception of colors. Spots appear in the field of vision, which can make everyday life difficult. Especially in children, macular edema can significantly limit and delay development. Due to the macular edema, the affected person is restricted in his everyday life in many activities and also in work.
The treatment of this disease usually depends on the underlying disease. There are no particular complications. Various medications or surgical interventions can alleviate or completely resolve the symptoms. The life expectancy of the patient is not limited or reduced by the macular edema. In severe cases, laser treatment can also be used. There are usually no particular complications.
When should you go to the doctor?
If changes in vision occur, it is advisable to consult a doctor. If you have reduced vision, blurred vision or blurred contours that are in the field of vision, a doctor should be consulted. Special medical tests are necessary to determine the cause of the disorders. If there are changes in color perception, there is also a need for action. As soon as the affected person notices in everyday life that their color definition differs from that of their fellow human beings, a visit to the doctor is recommended. In these cases, there is no spontaneous healing and non-treatment can result in blindness.
If you have a headache, a feeling of pressure in your eyes or inside your head, or if you are irritable, you should see a doctor. If the person concerned suffers from getting tired more quickly when looking, if he needs more strength in the eye muscles to adjust the visual acuity or if there are more accidents in everyday life due to the limited vision, a doctor must be consulted. Spots or shadows in the field of vision are another indication of an existing irregularity. If a haze is perceived in the field of vision, a doctor’s visit is necessary so that there is no deterioration in vision. If other people perceive that the person concerned is clumsy, they should speak to him about it and point out the need to see a doctor.
Treatment & Therapy
In principle, the underlying disease must be treated for the treatment of macular edema. Optimizing the metabolism in diabetes mellitus or reducing blood pressure in the case of high blood pressure can stop the progression of the disease.
Various active ingredients for further treatment of macular edema are currently being researched. An agent based on a so-called bisindolylmaleimide seems promising. In the case of focal macular edema, laser photocoagulation can also be used to prevent further deterioration of vision.
Outlook & Forecast
The prognosis of macular edema is usually good. As soon as the causative disorder has been determined, medical therapy takes place. Without treatment, an increase in symptoms and health impairments is to be expected. If the course is unfavorable, the quality of life is significantly reduced due to the impairment of vision. The risk of accidents increases and everyday obligations can no longer be fully met. As soon as the affected person consults a doctor, the causes of the edema are determined using various medical tests.
There are various treatment approaches that can be used according to individual specifications. In addition to medication, surgery may also be used. Although this is associated with risks, it is still a routine process that usually runs smoothly. Complications or other adversities that delay the healing process are rare.
Under optimal conditions, the patient can be released from treatment within a few weeks as symptom-free. Vision is restored. Nevertheless, the patient should take part in regular check-ups to prevent the symptoms from recurring. In particular, patients with diagnosed diabetes are well advised to have a positive prognosis if they take part in follow-up examinations at regular intervals.
Diabetics can prevent macular edema with a well-controlled blood sugar level. In addition, regular visits to the ophthalmologist are obligatory for diabetics. But everyone else should also have their eyes checked regularly and see an ophthalmologist immediately if they have vision problems.
Since the development of macular edema can often be traced back to an underlying disease, those affected are generally involved in long-term treatment by a doctor in order to prevent the occurrence of further complications or other symptoms. An early diagnosis usually has a very positive effect on the further course of the disease. The options for aftercare are therefore largely limited to regular visits to a doctor.
In the event that the eyesight has already been severely affected, the aftercare is aimed at minimizing the visual problems. The person concerned should therefore refrain from excessive exertion or stressful activities in which the eyes over. be moderately strained, such as working hours on the computer and trying to get visual aids if necessary. The correct setting is subject to a specialist ophthalmologist.
You can do that yourself
Depending on the cause of the macular edema, changes in behavior in everyday life and self-help measures can help to relieve the symptoms and prevent recurrence, the recurrence of macular edema. In many cases, the main cause is primary or idiopathic arterial hypertension and type 2 diabetes mellitus. Both underlying diseases promote damage to small and narrow vessels such as capillaries, so that tissue fluid or even blood can leak out.
The adjustment of everyday behavior consists above all in a careful adjustment of the sugar in the blood and in a consequent lowering of the blood pressure to tolerable values.
In both cases, relaxation techniques that promote the reduction of stress hormones and give priority to the parasympathetic nerve impulses serve to support drug therapy. For example, conscious breathing exercises, self-hypnosis and Far Eastern relaxation exercises such as Tai Chi, Qi Gong and Yoga are beneficial. The regularly performed exercises serve to set in motion self-repair mechanisms for the damaged vascular system via the parasympathetic nervous system. This reduces the risk of a retinal vein occlusion in the area of the macula. Retinal vein occlusions are the main cause of leakage of tissue fluid in the area of sharpest vision.