Who Gets Diabetic Macular Oedema; When; and Why? Pathogenesis and Risk Factors

Diabetic macular oedema (DMO) presents an enormous rise in the last decades with an increasing number of diabetic patients. It has a negative impact on the health-related quality of life beside the related visual loss. Additionally, it incurs more health centre visits, higher health costs, and lower working performance. Therefore, early diagnosis and preventive measures gain more and more importance in the management of DMO. Risk factors for DMO can be divided into systemic and ocular risk factors. The leading systemic risk factors include age, type and duration of diabetes, insulin use, and glucose regulation. Hypertension, nephropathy, hyperlipidaemia, anaemia, cardiovascular disease, smoking, and amputation are other risk factors reported. In addition, susceptibility in cases with endothelial nitric oxide synthase polymorphism and vascular endothelial growth factor C634-G polymorphism has been reported. The severity of diabetic retinopathy, microaneurysm turnover, cataract surgery, incomplete vitreous detachment, and peripheral retinal ischaemia are among ocular risk factors. Though avoiding changes in the metabolic memory related to hyperglycaemia in the early period seems to be the most efficient treatment, nowadays close follow-up of patients with high risk and effort to control the modifiable risk factors seems to be the ideal treatment.