Diabetes Care Community

Tag: eye exam

  • Diabetes and macular edema: what’s the connection?

    Diabetes and macular edema: what’s the connection?

    [vc_row][vc_column][vc_column_text]Diabetic macular edema (DME) is a complication of diabetes that can cause vision problems and even blindness. It may be prevented or delayed with good diabetes management. Some medications are available to treat DME. Read on to learn more about diabetes and macular edema.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][ad-slot slotcode=’div-gpt-ad-lb-resp-cont1′][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

    What is diabetic macular edema?

    DME is an accumulation of excess liquid in the hollow spaces in the part of your eye called the macula. The macula is part of the retina and is located at the back of the eye. It is responsible for your central vision, which allows you to see shapes and colours clearly and sharply.

    It is estimated that DME affects 7% of people living with diabetes.

    Are diabetic macular edema and diabetic retinopathy the same?

    DME and diabetic retinopathy are not the same condition, but they are related. Diabetic retinopathy is a disease that damages the blood vessels in the retina, resulting in impaired vision. When diabetic retinopathy is not treated quickly or effectively, fluid can leak into the macula, which results in DME.[/vc_column_text][read-also-article article-slug=”diabetic-eye-disease%c2%85/”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

    What causes diabetic macular edema?

    The 3 most common causes of DME are:

    1. High blood sugar
    2. High blood pressure
    3. High cholesterol

    What are the symptoms of diabetic macular edema?

    Common symptoms of DME include:

    • Blurred vision or double vision
    • The presence of ‘floaters’ (small dark shapes that float across your vision); they can look like threads, squiggly lines, or little cobwebs
    • Difficulty seeing colours
    • Dark spots or blind spots in your field of vision
    • Straight lines that you see as bent or curved
    • Difficulty seeing when there is a glare or bright light
    • Trouble reading
    • Difficulty recognizing faces

    [/vc_column_text][read-also-article article-slug=”risk-factors-and-warning-signs-for-diabetes-related-eye-damage/ “][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][ad-slot slotcode=’div-gpt-ad-lb-resp-cont2′][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

    How is diabetic macular edema diagnosed?

    If you are experiencing any of the symptoms noted above, it’s important to book an appointment with your diabetes healthcare team immediately. They will do a thorough eye examination and likely refer you to an eye specialist (ophthalmologist) for further tests.

    The first test is an examination of your eye with a device called an ophthalmoscope. It allows your doctor to look at the back of your eye. This part of your eye is called the fundus, and consists of the retina, macula, optic disc and blood vessels.[/vc_column_text][vc_single_image image=”39647″ img_size=”full”][vc_column_text]If the ophthalmologist sees abnormalities during examination with an ophthalmoscope, they will likely order a test called optical coherence tomography. This test uses light waves to take cross-section pictures of your retina. The ophthalmologist can then review and analyze these pictures and determine if you have DME.

    How is diabetic macular edema treated?

    There is currently no cure for DME. However, optimal diabetes management and medications can help slow its progression and limit the amount of vision damage you may suffer.

    When you have DME, your body makes too much of a protein called vascular endothelial growth factor (VEGF). This causes blood vessels to grow too quickly, so they’re weak and leak blood and fluid into your retina and macula. Anti-VEGF medications block the protein to help stabilize your blood vessels and prevent new ones from growing, which stops the leakage of fluid.

    The anti-VEGF medicines used in Canada to treat DME are:

    • Aflibercept (Eylea®)
    • Bevacizumab (Avastin®)
    • Ranibizumab (Lucentis®)

    These medications are given by injection. You may be given an injection once a month for the first 3 to 6 months of treatment. After that, fewer injections are needed.

    Another injectable medication was recently approved by Health Canada for people with DME. Faricimab (Vabysmo®) is a drug that targets both VEGF and angiopoietin-2, another protein that can build up in the eyes and contribute to DME. It is also administered by injection, but at less frequent intervals.

    In addition to anti-VEGF medications, steroid injections, special eye drops that contain NSAIDs (non-steroidal anti-inflammatory drugs) and laser therapy are also used to treat DME.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][ad-slot slotcode=’div-gpt-ad-lb-resp-cont3′][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

    Is there a way to prevent diabetic macular edema?

    Like many other diabetes complications, the key to preventing DME is to manage your diabetes as effectively as possible. This means:

    • Keeping your blood sugar at target levels
    • Controlling your blood pressure and cholesterol levels
    • Having an eye examination done regularly by an optometrist or ophthalmologist

    [/vc_column_text][read-also-article article-slug=”avoiding-or-delaying-eye-damage-from-diabetes/ “][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

    Are there any new treatments being developed to manage diabetic macular edema?

    Some new and innovative treatments for DME are currently being studied, and include:

    • High-dose anti-VGEF injections, which are given every 12 to 16 weeks instead of once a month
    • Eye drops that deliver the medication directly to the affected eye
    • Oral anti-VEGF medications, rather than injections

    Good diabetes control can help prevent or delay eye complications such as DME. If you are at risk for DME, it’s important that you have your eyes tested regularly. If you develop DME, treatments are available that can help you manage the condition and slow its progression.[/vc_column_text][/vc_column][/vc_row]

  • EXPERTS ANSWER COVID-19 QUESTIONS: VIRTUAL CARE

    EXPERTS ANSWER COVID-19 QUESTIONS: VIRTUAL CARE

    [vc_row][vc_column][vc_column_text]In this second of a four-part series, nurse and Certified Diabetes Educator, Gail MacNeil, discusses ‘diabetes management in an era of virtual care’ during COVID-19 with endocrinologist, Dr. Alanna Weisman, and nurse Certified Diabetes Educator, Violeta Nikolova.

    Here are their insights.

    Is it safe to get routine blood tests during this time?

    Yes, now is a good time to get blood work done, as the number of cases are decreasing and the risk of infection is lower. We are encouraging patients to book their appointments online to minimize their time in waiting rooms. But labs are well equipped and are using appropriate equipment and social distancing, so patients shouldn’t be putting blood work off. In fact, it’s probably an ideal time to get tests done before the fall and winter when we may see a resurgence of COVID-19 cases again. If we do see cases increase in the future, we may hold off on lab work. Also, patients who use continuous glucose sensors may not need to do routine bloodwork, so it’s a good idea to check with your doctor or diabetes care team before booking a lab appointment.

    How can I get a diabetes consultation, and what other support is available?

    You can talk to your doctor to be referred to a diabetes specialist and get access to a diabetes education team in your area. There may also be community pharmacists certified in diabetes education who can offer counselling and support in your area. Look for some great online diabetes resources available through sites like Diabetes Care Community and Diabetes Canada too.

    All diabetes clinics have to comply with provincial guidelines, so if in doubt about where to go, contact your diabetes care team to find out what is available to you.

    Can I still have my routine diabetes checkups during COVID-19?

    Most diabetes specialists are still connecting with patients with the same frequency as before, but using the telephone or virtual check-ups. As things continue to re-open, we may see a return to more in-person visits, however, expect that virtual visits will continue as well. While we can’t do everything online when it comes to patient assessments, there is a lot we can do, so you’ll likely see a combination of both types of appointments in the future. For certain things such as blood pressure monitoring and foot exams, for example, we’ll still want in-person visits.

    How can I monitor things like blood pressure, or get my feet, teeth or eyes checked?

    For blood pressure management, now might be a good time to invest in a home blood pressure monitor. (Check resources such as Hypertension Canada for information on the best, clinically approved home monitors.) As for foot, eye or dental care, it depends on your history and past complications, as well as your level of risk. If you don’t feel comfortable going out at this time, perhaps you can delay your visit or do it virtually. Keep in mind that COVID-19 may be here for a while, so for urgent concerns, be sure to contact your healthcare providers. You don’t want to delay care and risk future complications. For example, someone with active retinopathy or a foot infection should still be getting an examination. Your healthcare provider will advise on whether it is best for you to be seen in person.

    In the meantime, here are some resources for how to care for your feet when you have diabetes.[/vc_column_text][read-also-article article-slug=”coronavirus-support-services/”][vc_column_text]

    How can I get help with dietary needs during COVID-19?

    You can access a dietitian through your diabetes clinic, some grocery stores and even access a dietitian online. You can also find some good tips on what to eat for a healthy diabetes diet here.

    Is emergency non-COVID-19 care available if I need it?

    Absolutely! All healthcare providers are stressing the importance of seeking care when you need it. Hospitals are using strict protocols during this time and patients should not be afraid to come into the hospital. We recommend checking on what policies are in place for each healthcare environment in terms of COVID-19 protocols, but certainly don’t be fearful of accessing care for non-COVID-19 conditions.

    What will the future of diabetes care look like?

    Technology will continue to complement face-to-face patient visits. We’ll continue to communicate through phone, email, video and other digital means. Protocols such as mandatory personal protective equipment will continue, and so will designated entrance/exits to minimize traffic inside healthcare facilities. We also have to be flexible in terms of how care is delivered. At times we may be doing more in-person visits or we may shift back to more virtual care visits.

    How do I prepare for a virtual appointment?

    Have all your medical and drug information accessible and ready to share, including your blood sugar levels. Be sure to have your pharmacy contact available in case your provider needs to send in a prescription, as well as contact information for any other healthcare providers in your circle of care. Write down any questions you have so you don’t forget to ask.

    If possible, download your blood sugar values or take a picture of your log book to send to your provider ahead of time. The same goes for blood pressure readings.

    What platforms are being used for virtual care appointments and which one is best?

    Phone or video are the most common platforms used. There are advantages and disadvantages to both. Video is useful in being able to see a patient’s non-verbal cues and putting a face to a patient, especially for initial consultations. It is also easier to do demonstrations via video.

    On the other hand, not all people have access to the technology needed for video calls. The telephone is more accessible, simpler to use and less likely to have technical glitches. However, some of that personal connection that video enables may be lost.

    As mentioned above, COVID-19 may be here for a while, so don’t delay urgent concerns, and be sure to contact your healthcare providers.[/vc_column_text][read-also-article article-slug=”experts-answer-covid-19-questions-risks-complications-stress/”][/vc_column][/vc_row]