Are your eyes also suffering from diabetes? Have you heard of this condition called Diabetes-Related Macular Edema?

If you have diabetes, you have to take extra care of your eyes, right? Because, as you know, diabetes is a condition that can affect our eyes in unexpected ways. Today, we are going to talk about just such a thing, a swelling that occurs inside our eyes, especially in a very important part of our vision, due to diabetes. This is what doctors call `(Diabetes-Related Macular Edema)` or `DME`.

What is Diabetes-Related Macular Edema (DME)?

Simply put, DME is a swelling that occurs in the center of the retina, the area inside your eye called the macula, which is the part of the eye that we use to see things clearly. Think of it like your eye is like a camera, and the retina is like the film in that camera. This is where the photosensitive cells are located. So this part of the retina, called the macula, is what helps us read small print and see things that are far away clearly.

You are more likely to develop DME if you have diabetes-related retinopathy. Diabetes weakens the tiny blood vessels in your eye. They can then leak blood and fluid. Sometimes, new, very weak blood vessels can form that don't belong there. These can also leak easily. When this leaking fluid builds up in the macula, it swells.

How common is this condition?

Not everyone with diabetes develops this condition. However, it is said that about one in fourteen people with diabetes may develop this `DME` condition. Since the number of people with diabetes is increasing in Sri Lanka, it is very important to be aware of this.

What are the symptoms of this? See if you have these too...

Symptoms of DME may not come on suddenly, and sometimes they develop gradually. But be aware of these things:

• Blurred vision or double vision: This is a common symptom. You may find that your vision is blurry or blurry when you read, watch TV, or look at something far away.
• Floaters: The sensation of small black dots or spider webs moving back and forth in front of the eyes.
• Difficulty distinguishing colors: Some colors may be darker than usual or difficult to distinguish from each other.
• Scotomas: You may see a black spot in the middle or on the side of what you are looking at.
• Straight lines and crooked appearance: If you look at something like a straight edge of a door or a window sill and it looks crooked, stretched, or wrinkled, that is also a symptom.
• Sensitivity to bright light: It can be difficult to see in sunlight or bright lights, and the eyes may appear blue.
• What you see with one eye is seen differently with the other eye: Although this is a somewhat strange symptom, it can happen to some people.

If you have one or more of these symptoms, it's best to see an ophthalmologist without delay.

Why is this happening? What is the reason for this?

As I mentioned before, the main cause of this is uncontrolled high blood sugar levels over a long period of time. This damages the delicate blood vessels inside the eye.

We call the damage to the blood vessels in the eye caused by diabetes ``Diabetes-Related Retinopathy (DRR)``. There are two main cases of this:

1. `Non-proliferative DRR`: In this, the blood vessels weaken and small balloon-like bulges (microaneurysms) form outside the walls. These allow blood and fluid to leak into the macula.

2. `Proliferative DRR`: This is a slightly more serious case. Here, in place of the damaged blood vessels, new, very weak blood vessels begin to form inside the eye that don't belong there. These new blood vessels are very fragile, so they easily leak blood and fluid, causing the macula to swell.

The most important thing is that if this `DME` condition is not treated properly and on time, it can gradually lead to complete loss of your vision. So this is not something to take lightly.

How do doctors diagnose this condition?

You may not see this swelling from home. However, an eye doctor can detect it when they examine your eyes. That's why people with diabetes should have their eyes checked regularly. If it's detected early, it's easier to treat.

In addition to examining your eyes, the doctor may also perform special tests such as:

• Optical Coherence Tomography (OCT): This is like a scan of the inside of your eye. It can accurately measure the thickness of your retina and macula. It can clearly see if there is any swelling and how much.
• Fluorescein Angiography: In this test, a special dye is injected into a vein in your arm. Then, a special camera takes pictures of the dye as it travels through the blood vessels in your eye. Any leaks in the blood vessels will be clearly visible in the pictures.
• `Amsler Grid` Test: This is a very simple test. You are asked to look at a grid of squares and see if the lines are stretched, crooked, or missing. If there is a problem with the macula, you may see a change in these lines.

What are the treatments for this? Can it be cured?

The good news is that there are now very effective treatments for DME. With some new medications, if the disease is detected early, it is possible to reverse some of the damage that has been done.

There are several main treatment methods:

1. Anti-VEGF treatment: There is a protein called Vascular Endothelial Growth Factor (VEGF) that helps new blood vessels grow inside our eyes. This treatment involves giving a medicine that blocks the action of the VEGF protein as an injection into the eye. This injection is given once a month, or as often as needed. The following medications are most commonly used:

• `Aflibercept (Eylea®)`
• `Bevacizumab (Avastin®)`
• `Faricimab-svoa (VABYSMO®)`
• `Ranibizumab (Lucentis®)`

2. Steroid treatment: Steroids are also used to reduce swelling. These can be given as injections into the eye or as small implants (a long-lasting piece of medication) that can be placed inside the eye. Examples:

• `Dexamethasone (Ozurdex®)` (this is an `implant`)
• `Fluocinolone acetonide (Iluvien®)` (this is also an `implant`)

3. Laser treatment (Laser Photocoagulation): In some cases, laser light can be used to "seal" leaking blood vessels and stop the leak.

4. Vitrectomy: This is a surgery. This surgery is done to remove blood, fluid, or scar tissue inside the eye that is pulling on the macula. Not everyone needs this.

With any of these treatments, it is essential to keep your blood sugar and blood pressure under very good control, otherwise the results of the treatment may be reduced.

Are there any side effects or complications of the treatment?

As with any medical procedure, there are some minor risks involved, but the likelihood of complications is generally low.

• Because of the `injection`, there is a small chance that a germ could enter the eye. To prevent this, the eye is cleaned thoroughly before the `injection`.
• After the injection, small air bubbles may form inside the eye. These will disappear on their own in a few days.
• Redness and slight itching may occur. This may also be due to the solution used to clean the eye before the injection. Using artificial tears can help reduce these discomforts.
• Steroid treatments can sometimes cause cataracts or increased intraocular pressure. Therefore, the doctor will always check for this.

How soon will I feel better after treatment?

DME usually causes no pain in the eye. So rather than feeling "better" after an injection, the damage to the macula and retina is stopped or partially reversed. Your vision may gradually begin to clear.

After the `Injection` treatment, you will not be able to go to work or school. However, if you have a `Vitrectomy` surgery, it can take about two to four weeks to recover.

What can be done to reduce or prevent this from happening?

If you have diabetes, you may not be able to completely eliminate your risk of developing DME. However, there are many things you can do to reduce your risk:

• Control your diabetes well: Keep your blood sugar levels as your doctor recommends. Take your medication properly and control your diet.
• If you have other chronic diseases like high blood pressure, control them well.
• Be sure to have your eyes checked by an ophthalmologist at regular intervals. People with diabetes are recommended to have their eyes checked at least once a year.
• If you smoke, stop today. Smoking is also very harmful to the blood vessels in the eyes.
• Eat a healthy diet. Eat more fruits and vegetables.
• Exercise regularly.

If I have this condition, what will the future be like?

If you are diagnosed with DME and treated properly, the outlook is usually good. Especially if diagnosed and treated early, some new medications can even restore some of the vision that has been lost.

However, if left untreated, vision can become significantly impaired, making it difficult to function in daily life. That's why early detection and treatment are so important.

How should I take care of myself?

Although DME is a condition that affects the eyes, taking good care of your entire body can help control the condition.

• If you have chronic diseases like diabetes, high blood pressure, high cholesterol, or obesity, try your best to control them well.
• Eat a healthy diet and get enough exercise.
• Avoid smoking.
• Have your eyes checked at regular intervals, as recommended by your eye doctor.
• If you suddenly lose your vision, experience severe eye pain, or suddenly see a black screen in front of your eyes, see a doctor or go to a hospital immediately.

What questions should you ask the doctor?

When you go to see the doctor, don't forget to ask these questions:

• "What else should I know about this condition (Diabetes-Related Macular Edema)?"
• "What treatment method do you recommend is best for me?"
• "What are the side effects or complications of this treatment?"
• "How often should I get my eyes checked?"
• "What kind of symptoms are considered an emergency in this `DME` situation?"

The last thing I have to say is this...

Diabetes is a disease that can affect many parts of our body. Among them, the eyes play a major role. If you have diabetes, especially if you also have a condition called `diabetes-related retinopathy`, you are at increased risk of developing `DME`. This risk increases the longer you have diabetes.

Therefore, it is very important to have regular eye exams and detect any swelling or new blood vessels in the eye early. Because if the disease is detected early and treatment is started, there is a great chance of saving your precious vision. Sometimes, if treatment is started early, the damage caused by `DME` can be reversed.

So, take care of your eyes. When living with diabetes, make eye care one of your main responsibilities.

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