“Early Detection Can Save Vision”, ET HealthWorld

Authors: Dr. Vaishal Kenya and Dr. Sidi Hajare, cataract and refractive surgeons in Mumbai retinal surgeonmumbai

New Delhi: The results of the ICMR-INDIAB study have revealed the significant impact of diabetes in India. The numbers reveal a shocking reality: 101 million people have diabetes and 136 million people have pre-diabetes, far more than previously estimated. This is a sobering reminder of the health care challenges facing this country.

Have you ever thought about diabetic eye disease?

This is a disease that can affect diabetics and causes a variety of eye problems. Surprisingly, approximately 80% of people with diabetes develop some form of diabetic eye disease within 10 years of diagnosis. This can lead to severe vision loss and blindness. One common type of diabetic eye disease is diabetic retinopathy (DR). This can also affect blood vessels in the retina and cause other serious conditions such as diabetic macular edema (DME).

How does this affect diabetics?

People with DME/DR are vision-threatening conditions and can face increased social and emotional challenges, along with decreased functionality. This can lead to further pressure on family relationships, poor diabetes management, progression of eye disease, and further psychological stress. These effects can have a significant impact on disease management and treatment costs.

What causes DME and DR?

Both DME and DR are associated with elevated blood sugar levels. Prolonged exposure to high levels of sugar in the blood can damage the retina. The main cause of macular edema is diabetes, but it can also be caused by factors such as cataract surgery, macular degeneration, uveal inflammation, retinal vein occlusion, and radiation damage. Additionally, certain diabetes medications may contribute to the development of macular edema.

Who is at risk?

Anyone with diabetes is at risk of developing DME/DR. The risk factors for these conditions are similar, so it's important for people with diabetes to be aware of the following potential risks:

● The duration of diabetes becomes longer.

● Poor control of diabetes due to elevated hemoglobin A1c

● High blood pressure

●Hyperlipidemia

●Decrease in renal function

Be aware of the signs and symptoms!

In the early stages of DR, there are usually no symptoms. However, some people may begin to have difficulty reading or seeing distant objects. When blood vessels in the retina begin to bleed, black spots or floaters may appear. Prompt treatment is essential to prevent further complications.

In some cases, DME can present with symptoms such as decreased vision, blurred vision, altered color perception, distorted straight lines, wavy lines, dark spots in central vision, and difficulty reading. However, in some cases DME may not show any symptoms at all.

How is DME/DR diagnosed?

A retinal specialist, a doctor who specializes in eye diseases related to the retina, diagnoses DME/DR through a detailed history and laboratory tests. optical coherence tomography (OCT), fluorescein fundus angiography (FFA), and fundus photography are utilized to aid in the diagnostic process, including a simple and painless examination of the dilated eye.

DME/DR management

● Lifestyle changes: Tightly manage diabetes, high blood pressure, and hypercholesterolemia, along with dietary changes, weight loss, and exercise.

●Drug therapy: Currently, anti-VEGF is the main treatment option for DME. Recently, new intravitreal drugs targeting VEGF-A and angiopoietin-2 have joined the lineup to fight DME by reducing fluid leakage into the retina. Steroids are also used to reduce retinal swelling and improve vision, and represent a promising advance in eye care for people dealing with DME.

During the early stages of DR, an ophthalmologist monitors the function of the eye. Some patients require dilated eye exams every 2 to 4 months. Prompt treatment is important if symptoms progress. It is also important to effectively manage the patient's diabetes, blood pressure, and cholesterol levels.

How can I prevent diabetic eye disease?

Prevention of diabetic eye disease involves effectively managing diabetes through regular physical activity, a healthy diet, and strict adherence to medical advice. By taking these steps, you can significantly reduce your risk of developing DME/DR and protect your vision in the long term.

Future direction Numerous clinical trials are underway for the treatment of DME, and long-acting anti-VEGF drugs and cutting-edge drugs that target multiple pathways have the potential to reduce the burden of monthly injections for patients. I am envisioning a future where there is. Exciting advances in teleophthalmology and artificial intelligence are also emerging as screening tools for DME and DR, offering promise for early detection and intervention.

DME poses a significant threat to the vision of India's diabetic population. In the fight against DME, it is important to maintain strict systemic control as well as local treatment. Thanks to the advanced technology of OCT imaging, we now have a deeper understanding of the different patterns of DME, allowing for personalized treatment plans for each individual case.

It is essential for people with diabetes to have a thorough dilated eye exam every year. Screening for diabetic retinopathy is recommended for patients with type 1 diabetes 3 to 5 years after diagnosis, and retinal testing for diabetic retinopathy is recommended at the time of diagnosis for patients with type 2 diabetes. Diabetic retinopathy may initially appear without symptoms, but early detection is key to preserving vision. Regular exercise, maintaining a healthy diet, and adhering to your medication regimen can help prevent or delay vision problems.

sauce:

1. Anjana RM, Unnikrishnan R, Deepa M, et al India Health Report on Metabolic Non-Communicable Diseases: ICMR-INDIAB National Cross-Sectional Study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023; 11(7): 474–489.
2. https://eyewiki.aao.org/Diabetic_Retinopathy_Screening#:~:text=Duration%20of%20diabetes%20is%20a,%2C%2080%25%20will%20have%20Retinopathy.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712956/#:~:text=Diabetes%20Macular%20Edema%20(DME)%20is, Any%20Level%20of%20Diabetes %20Retinopathy.
4. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy#:~:text=Diabetes%20Retinopathy%20is%20caused%20by,vessels %20all %20over%20the%20body.
5. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1442-9071.2011.02599.x
6. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00411-9/fulltext
7. https://www.webmd.com/diabetes/diabetic-macular-edema-causes-symptoms
8. https://eyewiki.aao.org/Diabetic_Macular_Edema
9. https://retinatoday.com/articles/2013-apr/diabetic-macular-edema-the-indian-perspective
10. https://www.raleighop.com/retina/diabetic-eye-disease

Disclaimer:

The information provided is for educational purposes only and is not intended to replace your doctor's medical advice. Roche makes no representations regarding the application of therapeutic practices or medications through this educational initiative and is therefore not responsible for any direct or indirect damages arising therefrom. Please consult your doctor for further advice and treatment.

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