Diabetes is the fastest growing disease in Canada, currently affecting more than nine million people in this country. All those living with diabetes will likely develop diabetic macular edema (DME) — a condition that results in vision loss and possible blindness – at some point in their lives to various degrees. The good news is that, thanks to better awareness and new scientific breakthroughs in treatment, a lifetime of healthy vision is within reach for diabetics.

The diabetes-DME link

DME can be challenging to detect because, in its early stages, there may be no symptoms – no pain or discomfort. Eventually, diabetics with the condition will experience blurred or distorted vision and, if left untreated, it can cause blindness. That’s why annual eye exams are crucial for diabetics. Better medical imaging equipment means that a health professional like an ophthalmologist or optometrist can see what’s going on in the deep layers of the eye. Early detection gives someone with DME the best chance at maintaining good vision.

The root cause of DME is leakage that happens at the back of the eye in people who suffer from diabetes. The retina acts like a sponge, filling up with blood and cholesterol seeping out of microscopic holes of blood vessels, causing ongoing vision loss or blindness.

“These are among the smallest blood vessels in the body,” explains Edmonton-based ophthalmologist Dr. Matthew Tennant. “They are also the most delicate and easily damaged.” Over time, they deteriorate and break down because of high blood sugar levels, leading to DME.

Eyesight is precious. Losing it can have devastating effects, from being unable to work and loss of income, to robbing someone of their opportunity to watch their children grow up. The keys to dealing with DME and its life-altering effects are early detection and adequate, ongoing management of diabetes. Good control of blood sugar levels can reduce the chances of developing DME by 50 to 70 percent.

Scientific breakthroughs in DME treatment

The study of DME treatments has advanced tremendously in recent years with the cooperation and support of top medical researchers, pharmaceutical companies, ophthalmologists and government agencies who are working together to find and test the best options.

"See a medical professional regularly and book annual appointments with an optometrist to have an eye exam."

“For decades, the only treatment available was laser,” says Dr. Netan Choudhry, Director of vitreoretinal surgery at Herzig Eye Institute in Toronto. “It still exists; however, a recent breakthrough has led to treatments that have proven to be more effective.” That breakthrough is connected to the discovery of the role that higher levels of a hormone called vascular endothelial growth factor (VEGF) is playing in eyes with DME. 

Those with DME can now receive anti-VEGF injections to combat increased VEGF levels and help reduce fluid and swelling in the retina. This type of treatment is more effective than laser and is less damaging to the delicate tissue surrounding the retina. Dr. Choudhry adds, “We have also mastered the art of achieving anesthesia for the eye so it’s the best treatment right now.”

A recent study in the New England Journal of Medicine, authored by some of North America’s leading ophthalmologists, looked at three available anti-VEGF treatments, including two that are approved for the treatment of DME in Canada. The study found that the drug aflibercept was more effective than the other two therapies tested, especially in cases where moderate vision loss was already present.

“In patients with vision worse than 20/50 the results showed a substantial improvement in vision compared to other commonly used agents. This represents a paradigm shift in treating diabetic macular edema” Dr. Choudhry explains.

Patient empowerment

It’s important that everyone is proactive when it comes to his or her health. That’s especially true for diabetics who face ongoing challenges in terms of maintaining proper blood sugar levels. See a medical professional regularly and book annual appointments with an optometrist to have an eye exam.  Talk about what you can do to keep DME at bay and be prepared to learn more about potential treatment options for it. The rewards of taking charge of your health last a lifetime.