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HEALTH MATTERS: Understanding diabetic macular edema to protect eyesight

More than 29 million Americans are diabetic and nearly 1.4 million Americans are diagnosed with diabetes annually.

At least 382 million people worldwide have diabetes and that figure is likely to rise to 592 million by 2035 if preventative measures are not implemented.

Without a doubt, the diabetes statistics are staggering and prompt the continued need for health observance campaigns to remind people about the medical risks of being pre-diabetic and diabetic.

November is National Diabetes Awareness Month and World Diabetes Day on Nov. 14 calls attention to a global epidemic that can be prevented and managed if healthier steps and lifestyles choices are taken.

“Diabetes is a public health crisis,” said Dr. Charles Mayron, an ophthalmologist.

In November 2014, the JAMA Ophthalmology came out with a study stating that African Americans more than whites are at greater risk for a diabetic-related eye disease. While nearly 20 percent of all diabetics will develop diabetic macular edema (DME), the JAMA study shows that 16 percent of African Americans with diabetes accounted for 38 percent of the DME cases.

World Diabetes Day is celebrated on Nov. 14 in honor of Dr. Frederick Banting, a  co-discoverer of insulin in 1921. (Source: International Diabetes Federation)
World Diabetes Day is celebrated on Nov. 14 in honor of Dr. Frederick Banting, a co-discoverer of insulin in 1921. (Source: International Diabetes Federation)

Diabetes affects the blood vessel in the body.  An ophthalmologist examination can take a picture of the eyes where they can see blood vessel leaking (abnormal changes, blood spots and bulges in the eyes). The ophthalmologist will recommend the patient be examined by a primary care doctor who will do a physical with blood labs to check the blood sugars.

The problem is that a lot of people have diabetes or are pre-diabetic and don’t know it. Dr. Mayron says he sees lots of patients who are unaware.

“Patients will go to an optometrist to correct their vision,” he said. “Many eye diseases may have no apparent symptoms in their early stages. Signs can remain hidden unless detected through a dilated eye exam, an optical coherence tomography (OCT).

“The mapping from the OCT exam can show signs of diabetes,” Dr. Mayron added.

Some early warning signs are after a meal with a lot of carbohydrates which spike sugar levels, an individual’s vision may get blurry; or once damage occurs, a patient may have difficulty seeing, reading the computer or cell phone screen or the newspaper.

DME occurs when high blood sugar levels damage the tiny blood vessels in the eyes, causing eyesight distortions, cloudiness, floaters and fuzziness, and, if not treated, blindness.

“Swelling of the macula blurs central vision, interferes with daily tasks, such as reading, watching television and driving,” Dr. Mayron said. “If left untreated, DME can result in irreversible vision loss.”

The Times of India reports that on a global scale, 93 million people have diabetic retinopathy (DR), including 21 million with DME; another 300 million people are at risk. The leading cause of blindness in American adults is the result of diabetic retinopathy. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or bleed, causing vision distortion.

People with all types of diabetes are at risk for DR. About half of all people with DR will develop DME. DME is the build-up of fluid in the macula, which is essential for vision used for reading, recognizing faces and driving.

“The retina is like a sponge, when the blood vessels leak, it thickens and causes the edema,” Dr. Mayon said.

Risk factors for diabetic retinopathy include high blood pressure, high blood sugar, genes and how long the patient has been diabetic.

diabetesdmeinfographicrev

India ranks second in the world, with 90 percent of the population having Type 2 Diabetes and only 10 percent of the 77 million people with pre-diabetes are aware of their condition.

“Diabetic retinopathy is a slowly progressing asymptomatic disease, not all individuals feel an urgency to begin treatment,” said Dr. Kiran Shah of Aditya Jyot Eye Hospital in Mumbai, India. “Many people with diabetes do not understand how DR will affect their lives and their independence until they lose their driver’s license.”

Margaret York, 71, was first diagnosed with diabetes about 25 years ago. Her doctors were able to manage her diabetes with insulin and other medications but she developed diabetic retinopathy, which usually affects both eyes.  Four years ago, her left eye was more problematic because her health weakened with the flu and heart issues and she needed a more aggressive treatment.

“I recommended to my long-time patient Margaret York to get the iluvien implant, which releases corticosteroid for three years,” Dr. Mayron said. “The convenience of the implant reduces the number of times Margaret needed to come to the office and get injections in her eye.”

She is among the first in the United States to be treated for DME with iluvien, which was FDA approved last year.

Prior to Iluvien, a diagnosis of DME meant patients had to go in for monthly eye injections of a corticosteroid to repair the leaky blood vessels.

Diabetic retinopathy is the leading cause of vision loss and blindness among working-age Americans.  It is no longer a disease of seniors.  It is affecting the younger generation.  Getting eyes examinations and a thorough evaluation of the retina annually should be the rule of thumb. (Source: nei.nih.gov)
Diabetic retinopathy is the leading cause of vision loss and blindness among working-age Americans. It is no longer a disease of seniors. It is affecting the younger generation. Getting eyes examinations and a thorough evaluation of the retina annually should be the rule of thumb. (Source: nei.nih.gov)

While some of the problem was hereditary — both parents had diabetes and high blood pressure — York also admitted to eating unhealthy food.

She watched her parents suffer.  “My mother lost both her legs to diabetes,” said York, who is thankful her doctors were able to help control and manage the diabetes. York also had both poor leg circulation, but she was given a bypass to change that.

York learned to eliminate foods that would cause her a problem. She gradually changed her diet by eating more vegetables without adding salted meat. She is from the South and used to eating comfort foods all the time (fried foods and sweets). Like her mother, she loved baking foods.

“My husband of 23 years does all the cooking and it’s bland but I know it’s better for me,” York said. “He has high blood pressure and we look out for one another.”

She stopped baking. Her husband learned to bake for himself.

“My fun with food and my driving days are over but the ability to be healthy enough to enjoy family and friends is a better gift,” York said.

“Would you rather be a healthy person or a patient?” Mayron said. “Change your lifestyle so you can avoid being drug dependent.“

National Eye Institute’s Ten Points to Remember

1. Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma.

2. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.

3. Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision.

4. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults.

5. DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula.

6. Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss.

7. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.

8. Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss.

9. Diabetic retinopathy can be treated with several therapies, used alone or in combination.

10. NEI supports research to develop new therapies for diabetic retinopathy, and to compare the effectiveness of existing therapies for different patient groups.

Dr. Mayron’s words of wisdom, “Don’t assume the doctor can take care of diabetes.  Get and stay healthy.  It’s a team effort – patients need to do the work so the doctor can use the tools available to help the patient.”

Resources:

National Eye Institute – www.nei.nih.gov

American Diabetes Association – www.diabetes.org

American Academy of Ophthalmology  – www.aao.org

EyeCare America – www.aao.org/eyecare-america

Eye Care 4 Kids  – www.eyecare4kids.org

Alimera Sciences – www.alimerasciences.com

Aditya Jyot Eye Hospital – www.adityajyoteyehospital.org

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Marie Y. Lemelle, MBA, a public relations consultant, is the owner of Platinum Star PR and can be reached on Twitter @PlatinumStar or Instagram @PlatinumStarPR. Send “Health Matters” related questions to healthmatters@wavepublication.com and look for her column in The Wave.