Diabetic macular edema and your blood pressure and diabetes medicines

The eye is naturally affected by events going on elsewhere in your body. Patients with problems such as diabetes, high blood pressure, and/or congestive heart failure often “hold on to water” and may have swelling of the ankles and hands.

Even though it’s not a strict correlation, this “holding on to water” and swelling may also translate to more swelling in the center portion of the retina, the macula. This macular swelling, or macular edema, can reduce vision.

As a retina doctor, we can often perform laser on the macula to reduce swelling. We can also inject special medicines to reduce swelling. These interventions often work well, but sometimes they do not work as well as we would like. Patients who have uncontrolled blood pressure, diabetes, or ankle swelling from “holding on to fluid” tend to respond less well to laser and injections.

If a patient has macular edema and that patient also appears to have swelling of the ankles or hands, or to have uncontrolled high blood pressure, Dr. Dahr may recommend that the patient’s internal medicine or diabetes doctor reduce the blood pressure. Dr. Dahr may also recommend that the internal medicine doctor try to reduce ankle swelling with diuretics such as Lasix. Sometimes “getting this fluid off”, or diuresing the patient, may help with the retinal swelling as well.

Control of sugars in diabetic patients also influences the retinal swelling, and Dr. Dahr may recommend better sugar control. Blood pressure, anemia, and sleep apnea may all also affect retinal swelling.

One caveat: a new class of diabetic medicines known as the “glitazones” and going by the names of Actos (pioglitazone) and Avandia (Rosiglitazone) may actually aggravate diabetic macular edema. In certain circumstances, Dr. Dahr may recommend that you discuss with your diabetes doctor switching to a different medicine.