A study published in the journal JAMA Ophthalmology reveals that less than 50% of US adults with diabetic macular edema (DME) are told by their doctor that diabetes is the cause of their condition, and less than 60% have had a dilated eye exam in the last year.
Whether caused by diabetes or not, DME is a serious condition that can lead to vision loss if left untreated.
What is Diabetic Macular Edema?
Diabetic macular edema is a complication of diabetes that causes fluid to build up under the retina and interfere with the ability of the eye to see fine details. It is estimated that more than 1.5 million people in the United States have DME, but only half of them know it.
DME is the leading cause of vision loss among people with diabetes. Diabetes is the most common cause of DME, but other factors can also play a role. The most common symptoms of DME are blurry vision, floaters, and seeing halos around lights.
DME is a form of diabetic retinopathy, the leading cause of blindness in people with diabetes, and occurs when the blood vessels in the eye’s macula – central part of the retina responsible for sharp vision – leak fluid and swell. This can lead to partial vision loss or total blindness.
How is Diabetic Macular Edema Treated?
Prompt treatment of the condition can prevent sight loss, but in order to catch the condition early, patients with diabetes need to undergo regular dilated eye examinations.
If we could find a way to detect retinopathy, or even the earliest stages of retinopathy, then those patients would be able to get the treatment they need before the disease has a chance to progress.
Those who have diabetes should get their eyes examined at least annually to detect diabetic retinopathy in the early stage.
This is the stage when the damage to the retina is reversible. If caught in time, one may be able to slow the progression of diabetic retinopathy. When the condition becomes too advanced and damage to the retina is irreversible, we have a few options:
Injections into the eye and various methods of laser treatment are performed to try to prevent further progression of the disease.
If diabetes is uncontrolled, one can be placed on insulin. The reason for this is that the addition of insulin will lower the blood glucose level.
Thus, the amount of sugar reaching the retina will be reduced. This should protect the retina from further damage. Controlling diabetes is usually successful in managing many cases of progressive macular damage.
In the light of this research, it is a reasonable conclusion that lowering the blood sugar level may be a promising way to treat macular damage in addition to eye injections and lasers. This would be true regardless of the cause of the damage.
Diabetes Causes Damage to All Organs
If you have diabetic retinopathy, your other organs are also likely to be damaged because of high blood sugar.
This means that your kidneys, heart, nerves and blood vessels are all at risk. If you have diabetic retinopathy, you should get your eyes examined as soon as possible. The earlier the condition is detected, the better the chance of reversing the damage.
If you have diabetic retinopathy, your doctor will be able to tell if you have macular damage or not. If you do have macular damage, your doctor will be able to tell if you have mild, moderate or severe damage. The severity of the macular damage will determine what treatment is necessary. As mentioned above, macular edema is a swelling of the macula, which is caused by a buildup of fluid in the macula.
Prevalence of Diabetic Macular Edema
To determine the awareness of eye care and eye disease among diabetic patients, a team of researchers, led by Dr. Neil M. Bressler of The Johns Hopkins University School of Medicine and Hospital and editor of JAMA Ophthalmology, analyzed 798 participants from the National Health and Nutrition Examination Survey, who had self-reported diabetes.
Of these, 238 had diabetic retinopathy without DME, while 48 had DME. With an average age of 59 years, the study subjects had an average glycated hemoglobin (HbA1c) of 8.1%. The participants underwent eye examinations, which included dilated retinal photography and a visual field test.
The researchers found a statistically significant correlation between higher HbA1c levels and increased odds of glaucoma and retinopathy. For example, an increase from an HbA1c level of 8.1% to 8.5% was associated with a 176% increase in the odds of glaucoma, while the same increase in HbA1c from 5.9% to 6.4% was associated with a 111% increase in the odds of retinopathy.
Patients Not Aware of Their DME
Results of the study revealed that only 44.7% of those with DME said they had been told by their doctor that their eyes had been affected by diabetes, or that they had diabetic retinopathy.
“It is very important for patients with diabetes to be aware of the risk of developing diabetic retinopathy and macular edema, and to seek timely eye care if they notice any changes in vision,” said Bressler. “This study shows that many people with diabetes are unaware of these conditions and the need for eye care.” The researchers also found that the odds of having glaucoma or retinopathy were higher among those who reported being told by a physician about the risk of developing these conditions.
Furthermore, only 46.7% of diabetic individuals with DME said they visited a diabetes nurse educator, dietician or nutritionist for their diabetes more than 1 year ago or never, while only 59.7% said they had a dilated eye exam within the past year.
Commenting on their findings, the researchers said “Our results suggest that many individuals with DME report not receiving prompt diabetes-related or eye-related care, although many of these individuals are at risk of significant visual loss that could be lessened or eliminated with appropriate care.”
The researchers also said that the findings highlight the need for public health initiatives to increase awareness of the risk of developing these conditions and to promote eye care among people with diabetes. “We know that people with diabetes are at high risk of developing diabetic retinopathy and macular edema, but it is important for people to seek eye care if they notice changes in vision,” said Bressler.
This is not the only study to find that diabetic patients lack awareness when it comes to their risk of diabetic eye disease and the importance of regular dilated eye examinations. A recent survey from Diabetic Connect – a social networking site for diabetes sufferers and their families – found that 25% of people with diabetes do not have the recommended annual dilated eye exam.
According to the National Eye Institute, people with diabetes who undergo a dilated eye exam once a year could reduce their risk of severe vision loss by 95%. The examination involves an ophthalmologist, optometrist or retina specialist putting drops into a patient’s eye, which allows them to clearly assess the retina to see whether there is any diabetic damage or early signs of disease.
This is a great way to detect and monitor diabetic retinopathy and diabetic macular edema in patients who have diabetes.
Early Detection Prevents Permanent Visual Loss
Early detection and management of diabetes is the first step to prevention of diabetic cataract, diabetic retinopathy and diabetic macular edema.
If you already have diabetes, then early detection of diabetic eye disease means the patient can be offered various treatment options to help prevent partial vision loss or blindness. These include laser eye surgery and injections of anti-vascular growth factor (anti-VEGF) medications, which tackle abnormal blood vessel growth in the eye.
These treatments are typically used to treat abnormal blood vessels, which may damage the macula. This is a small area of the retina that is responsible for detailed central vision.
The researchers say that although treatment for diabetes-related vision loss has improved, their findings suggest diabetic patients lack awareness when it comes to their risk of diabetic eye disease, and more effort is needed to educate them in this area.
Kazumasa Niwa, MD, PhD, of the Department of Ophthalmology at Nagoya City University Graduate School of Medical Sciences in Japan, and colleagues have found that a patient’s subjective perception of their diabetic retinopathy has a significant correlation with the severity of their disease.
They found that those who felt they were in control of their diabetes were more likely to have mild to moderate non-proliferative diabetic retinopathy, and this had a significant impact on their life quality.
In addition, the researchers found that perceived control of diabetes was positively associated with adherence to screening guidelines for eye disease and this too, made a significant impact on patients’ quality of life.
The study was published in the journal Diabetes Care. The researchers say that although it is important to educate patients about the importance of regular eye exams; it is also important to help them understand that they are responsible for their own eye health. “We should emphasize that diabetic retinopathy is not just a medical problem, but also a social issue,” said Dr Niwa.
“These efforts include getting patients to health care providers, including diabetes nurse educators, dieticians, nutritionists, primary care physicians, or endocrinologists, for treatment of their diabetes mellitus; getting appropriate eye examinations to detect and treat diabetic retinopathy, including DME,” they note.
“Diabetes is a chronic disease and we need to be patient and persistent in our efforts to educate and help patients with their diabetes and its complications,” they conclude.
They add that strategies should be identified that “might result in greater awareness and appropriate eye care to reduce the magnitude of visual impairment and blindness due to this common complication of diabetes mellitus.”
Regular Eye Examination is Important
It’s always good to be in follow-up with your eye doctor if you have diabetes.
The American Academy of Ophthalmology (AAO) estimates that more than half of those with diabetes have been diagnosed with diabetic retinopathy. The AAO recommends that patients with diabetes be screened regularly for diabetic retinopathy.
In addition, the AAO suggests that patients with diabetes who have retinopathy be treated as soon as possible to prevent vision loss. They also recommend that patients with diabetes be educated about the importance of regular eye examinations and be encouraged to follow up on abnormal findings.
They recommend that patients with diabetes who develop retinopathy be referred to an ophthalmologist or optometrist for appropriate treatment. “This can help preserve vision and reduce the risk of blindness”.