IMPACT OF CENTER-INVOLVED DIABETIC MACULAR EDEMA ON VISION-RELATED QUALITY OF LIFE IN PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL STUDY

Abstract

Diabetic macular edema (DME), characterized by retinal thickening involving the macula, stems from retinal capillary dysfunction, notably increased vascular permeability due to diabetic retinopathy (DR). It can occur across all severity levels of DR and is a leading cause of vision loss in patients with diabetes mellitus (DM). While management of DM considers DR severity and DME presence/type, conventional DR assessment overlooks the patient's perspective and vision-related quality of life (VRQoL). Addressing VRQoL is crucial in DM management, serving as a significant therapeutic gauge. The objective of this study was to evaluate center-involved DME (CI-DME) impact on VRQoL. We conducted an observational cross-sectional study on patients with DM aged above 18 years at a Brazilian Unified Health System (SUS) diabetes clinic from June 2022 to May 2023. VRQoL was assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Patients with apparent DME underwent spectral-domain optical coherence tomography (SD-OCT) for confirmation. CI-DME was defined as central subfield thickness ≥ 275 μm on SD-OCT. NEI-VFQ-25 scores were compared using Kruskal-Wallis test. The final sample included 95 patients, with 72 (75.7%) without DME or non-center-involved DME and 23 (24.2%) with CI-DME. CI-DME patients showed significantly lower mean NEI-VFQ-25 scores across multiple domains, including general vision, distance activities, mental health, functional limitation, and dependency (p < 0.05). Total score means also indicated statistically lower values in CI-DME patients (p < 0.05). In conclusion, CI-DME was associated with lower VRQoL scores. Effective DME management, alongside DR progression prevention, should be a treatment goal to improve VRQoL for DM individuals.