With diabetes on the rise in the UAE, understanding Diabetic Macular Edema or DME and its symptoms is paramount. HEALTH met with Dr. Ahmed El Khashab, Ophthalmology Consultant and Vitreo Retinal Surgeon at Eye Consultants Center Dubai Healthcare City to learn more…

Defined

DME, points out Dr. El Khashab,is the leading cause of moderateto-severe vision loss in patients with diabetes, and a leading cause of blindness in working-age populations in most developed countries. “DME can be simply understood if divided it into its components; ‘D’ for diabetic and ‘M’ for macula or the central part of the retina which is responsible for the central vision and ‘E’ which stands for edema, the accumulation of fluid and exudates,” he explains, therefore DME is the accumulation of fluid and exudates in the macula in diabetic patients. “DME occurs when blood vessels in the retina leak fluid and proteins into the macula, causing the macula to swell, which in turn affects visual function,” he says. “DME is not a congenital disease, it is a complication of diabetic retinopathy, and it can develop at any stage of Diabetic retinopathy, but also may not occur.”

The visual symptoms are usually signs of more advanced disease, they include:

• Lack of precise focus
• Colors look faded or washed out
• Small patches of vision loss
• Straight lines look bent or crooked

Symptoms

As early DME is asymptomatic and can progress to a severe stage without the patient noticing, Dr. El Khashab advises that regular and frequent eye examinations are necessary to detect early pathologic changes as well as to monitor on-treatment progress.

Health Problems Associated with DME

DME is a complication in diabetic patients with diabetic retinopathy which is associated and aggravated by other factors which includes:

• Poorly controlled diabetes

• Chronic, long-lasting hyperglycemia

• Dyslipidemia

• Hypertension

• High body mass index

• Low levels of physical activity

Treatment

According to Dr. El Khashab, DME is not a curable disease. However now, with the development of new treatments, the goals of management have changed from reducing the rate of disease progression and loss of vision to stabilizing disease/vision loss. Once laser alone was considered as the standard of care but now it reached a level where improving visual function and potentially reversing the disease progression can happen. This, he explains, was achieved by the introduction of the vascular endothelial growth factor inhibitors, which are given as intravitreal injections (injections given inside the eye) which can inhibit the factor that causes the accumulation of fluids inside the macula.

Inevitable?

By the second decade after diagnosis, diabetic retinopathy (DR) affects almost all patients with T1DM and approximately 60 percent of those with T2DM. So most people with diabetes will eventually develop retinopathy of course taking into consideration the risk factors stated above.

Precautions to Be Taken

Diabetic retinopathy, progressing to DME, is almost inevitable in chronic (uncontrolled) hyperglycemia. Improved medical management therefore has the potential to reduce incidence of DME.

General prevention measures important for all patients with diabetes, knowing that there are many modifiable risk factors that can prevent the disease or make it happen later.

The Modifiable risk factors include:

• Hyperglycemia
• Hypertension
• Dyslipidemia
• Obesity

Also remember that timely treatment saves sight. Because DME can occur in even well-controlled diabetes therefore, we need the diabetic patients to understand the importance for regular eye examinations for retinal pathology, and to do regular clinical monitoring for their eyes.

Is there a Cure?

Unfortunately, Dr. El Khashab tells that there is no cure in the pipeline. But what we have now is the Intravitreal Anti VEGFs which has a big role in improving the vision for the patients but we have two main points to keep in mind:

• Controlling blood sugar is a crucial factor in achieving the best results for treatment otherwise the results will be always less that desired.
• Adherence to the treatment plan set by the physician as also very important.