Detecting diabetic macula oedema

What is diabetic macular oedema (DMO)?

Diabetic Macular Oedema (DMO) is a complication of diabetes, which causes leakage and thickening of the retina and macula. The retina is a nerve layer at the back of the eye which needs to remain thin to function, and the macula is the central part of the retina, responsible for high resolution, colour vision. The network of vessels which supply nutrients to the retina can become damaged if a patient has consistent high blood sugar.¹ This can result in diabetic retinopathy at the edge of the eye, which can lead to diabetic maculopathy in the centre of the eye.²

How would DMO be diagnosed?

DMO is commonly diagnosed at a retinal screening appointment; a service which all diabetic patients in the UK are advised to attend. Occasionally, maculopathies can be picked up in an optician’s appointment, via an optical coherence tomography (OCT) scan.³  Unfortunately, some patients do not understand the importance of eye tests as they experience no symptoms at an early stage.

How does DMO impact patients?

A great concern for patients is losing their career⁴ and independence.⁵ It is important to attend regular appointments to receive treatment, however, this can cause anxiety when they have work commitments and do not have an understanding employer. DMO can impact driving standards,^6,7 which can result in patients missing their appointments, adding to their anxiety. Fortunately, as we can detect DMO at an early stage, many patients’ eyesight does not deteriorate as we are proactive with treatment.

Do you see differences in DMO patients within wider diabetic care?

In general, patients are very well informed about their diabetes and its associated care, with many instruments available to measure their glycaemic control. However, this is not common with DMO as many patients are asymptomatic when first diagnosed⁸ so it is a new disease for them to understand.

Since the pandemic, do you see any opportunities in the clinic?

In the health service, it can be difficult to make change. At the peak of the pandemic, all non-urgent appointments were cancelled, and we made this an opportunity to go down the virtual clinic route. Patients had to fit strict criteria to be eligible for treatment; this was extremely difficult for patients who required monthly intravitreal injections as they would not be able to receive their treatment. It would be detrimental to their vision to not receive timely injections.⁹ This highlights the importance of exploring longer acting treatment options for patients as this does not require frequent visits to the clinic.

Since the pandemic, has there been a change in health care attitudes?

Unfortunately, many patients have experienced anxiety and depression if they have not been able to work, nor receive treatment. As a result, some have not maintained a healthy lifestyle and their retinopathy has worsened.

What do you think can be done better by healthcare professionals to help improve care for patients with DMO?

An important question to ask your patient is ‘who looks after your diabetes?’ A few patients are visiting the eye clinic but not seeing another specialist for their diabetes. I therefore think it is a significant need for departments and healthcare professionals to liaise more with each other, especially in the case of diabetes care. It is important to work together and ensure our patient’s glycaemic control is adequate and they are receiving all appropriate treatment.

Do you think there are any gaps in the market for patient disease awareness tools?

At present, patients are given an information leaflet when they sign a consent form and depending on their visual acuity, some are directed to a visibility charity. Therefore, I think all informative materials will be accepted and welcomed. In addition, the opportunity to connect with more charities and patient advocacy groups will further increases awareness.

Date of Preparation: March 2021
Job bag number: UK-NON-2150042

References

1. International Diabetes Federation. Diabetic Macular Edema (DME). Available from: https://www.idf.org/our-activities/advocacy-awareness/campaigns/54-our-activities/ 562-diabetic-macular-edema-dme.html Accessed March 2020
2. Mathew C, Yunirakasiwi A, Sanjay S. Updates in the management of Diabetic Macular Edema. Journal of Diabetes Research. 2015;2015:1-8.
3. Jiménez-Báez María V, et al. Early diagnosis of diabetic retinopathy in primary care. Colombia Medica, 2015; 46(1):14-8.
4. Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review. Coope OAE, Taylor DJ, Crabb DP, Sim DA, McBain H. Diabet Med. 2020; 37, 924– 933
5. Cumberland PM, Rahi JS, UK Biobank Eye and Vision Consortium. Visual function, social position, and health and life chances: the UK Biobank Study. JAMA Ophthalmol 2016; 134(9): 959–966.
6. A nine-country study of the burden of non-severe nocturnal hypoglycaemic events on diabetes management and daily function. Brod M, Wolden M, Christensen T, Bushnell DM. Diabetes Obes Metab 2013; 15(6): 546–557.
7. Driver and Vehicle Licensing Agency (DVLA). Diabetes mellitus: assessing fitnesss to drive. Available at: https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-to-drive
8. Management of retinal vascular diseases: a patient-centric approach. CS Brand. Eye (2012) 26, S1-S16
9. Action on diabetic macula oedema: achieving optimal patient management in treatment visual impairment due to diabetic eye disease. Gale R, Scanlon PH, Evans M, Ghanchi F, Yang Y, Silvestri G, Freeman M, Maisey A, Napier J. Eye (Lond) 2017 May; 31(Suppl 1): S1–S20