Diabetic Macular Edema (DME)

People with diabetes are at a higher risk of developing a condition that could harm their eyesight¹. One such condition is diabetic macular edema, which impacts one in every three long-term diabetics².

The eye, retina, and macula

Your retina is the tissue at the back of your eye that enables vision. It consists of photoreceptor cells that convert incoming light into signals your brain can interpret. There are two types of photoreceptors: rod cells, which are sensitive to low light, and cone cells, which allow you to perceive color.

Cone cells are densely packed in an area of the retina called the macula, which provides central vision and is crucial for many everyday tasks like reading or driving a car.

What is diabetic macular edema (DME)?

The retina holds small, delicate blood vessels called capillaries that provide oxygen and nutrients to the photoreceptors. In diabetes, blood sugar levels rise above normal. Elevated blood sugar, if not controlled, can damage the capillaries in the retina.

Damaged capillaries release a protein known as vascular endothelial growth factor (VEGF). VEGF causes capillaries to leak fluid into the macula, the area responsible for sharpest vision on the retina. It also triggers the growth of new blood vessels (neovascularization), which may also leak fluid.

The leaked fluid causes swelling (edema) – known as diabetic macular edema (DME) – which distorts the macula, leading to blurred vision. If left untreated, DME can result in total loss of central vision.

Around one in every three people with diabetes for 20 years or more are likely to develop DME³. Today, about 27 million people globally are affected by DME⁴.

Recent estimates suggest that there are 77 million persons with DM in India. Considering conservative estimate of 2% persons with DM having DME, likely magnitude of treatable DME is 15,40,000 persons⁵.

How can I prevent DME from happening to me?

If you have diabetes, the most essential action is to ensure your blood sugar level is well-regulated to prevent damage to the fragile capillaries in your eyes. Your doctor can provide guidance if you have concerns regarding your diabetes management.

Regular visits to an eye specialist are also vital, so any early signs of capillary damage in the retina can be detected and treated. If you experience blurred vision, you should immediately consult an eye specialist.

How is DME treated?

Various treatment options exist for DME. Some patients receive treatment with a specialized laser that seals leaking capillaries and reduces swelling. Others are treated with steroids injected directly into the eye in order to reduce inflammation.

Another category of medications, called anti-VEGF therapies, target the vascular endothelial growth factor (VEGF). These medications, when injected into the eye, block the VEGF protein and help reduce existing swelling.

Anti-VEGF therapies can reduce existing edemas and shrink newly formed pathological blood vessels in the choroid. This allows photoreceptor cells that have not yet been fully destroyed to be preserved, potentially stopping progressive blindness and even improving visual acuity in some patients.

Traditional anti-VEGF treatments require frequent injections, which can place a significant disease burden on patients. Some DME patients may struggle with adherence. Furthermore, because injections must be given at a healthcare facility, the burden can extend to patients’ caregivers.

Treatment options that offer longer treatment intervals can address a critical unmet need for DME patients by reducing the number of injections needed, enabling patients to spend more time on activities that matter to them.

Bayer is committed to improving treatment options for the benefit of patients in need.

Advice for patients

The information provided here is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.

References

Am J Manag Care. 2016;22:S284-S291
Varma R, Bressler NM, Doan QV, et al. Prevalence of and Risk Factors for Diabetic Macular Edema in the United States. JAMA Ophthalmol. 2014;132(11):1334–1340. doi:10.1001/jamaophthalmol.2014.2854
Duphare C, et al. Diabetic macular edema. In: StatPearls [Internet]. USA: StatPearls Publishing. 2023.
Cheung N, et al. Eye (Lond) 2020;34:999–1002.
Kulkarni S et al. Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India. Indian Journal of Ophthalmology 69(3):p 671-676, March 2021

Click here for Bayer Ophthalmology website

Age-Related Macular Degeneration (AMD)

In age-related macular degeneration, the nerve cells in the macula—the part of the retina responsible for sharp vision—are damaged. This happens due to deposits under the retina caused by local disturbances in retina metabolism.²

Age-Related Macular Degeneration: The Leading Cause of Blindness in People Over 65

As you age, you have more experience, wisdom, and better foresight. But about 170 million people worldwide suffer from age-related macular degeneration (AMD), making it the most common cause of severe visual impairment and blindness in people above 65 in developed countries.² As societies grow older, the number is expected to rise to 288 million by 2040, with women being affected more than men.³ The overall prevalence of AMD in India ranges from 1.4% to 3.1%⁴. Vision loss impacts one’s daily life, causing loss of independence, falls, injury, and negatively affects cognition, mental health, and employment.³

Early symptoms of macular degeneration

The first sign of AMD, in most cases, is when straight lines start to look bent. Further symptoms can become evident when reading-letters become blurry, and only a vague shape is visible.² Over time, the size of this blurry area grows, making it difficult to recognize faces or tell time on a clock. AMD typically starts in one eye, but the second eye is often affected later.²

Different forms of AMD

Dry AMD: The most common form, it progresses slowly and usually results in limited vision loss.²
Wet AMD: This more severe form makes up about 10% of AMD cases and can lead to serious vision loss. It occurs when tissue fluid and blood leak from pathologically changed blood vessels into the macula, causing edemas (swellings caused by fluid accumulations).² Moreover, new, diseased blood vessels develop in the choroid beneath the retina. Consequently, the nerve cells of the retina gradually degenerate, and central vision may be lost within a few years. If excessive bleeding occurs, sight could be completely lost instantly. Measuring the thickness of the retina can help determine how active the disease is.²

An active substance for treating wet AMD

Medications that block the vascular endothelial growth factor (VEGF) are widely used in treating wet age-related macular degeneration (wet AMD). VEGF is a naturally occurring protein in the body. Its typical function in a healthy body is to stimulate the formation of new blood vessels (angiogenesis), supporting the growth of tissues and organs.¹ However, it is also linked to the growth of abnormal blood vessels in the eye, which have increased permeability, resulting in edema.¹ Anti-VEGF therapy targets and slows down the abnormal growth of new blood vessels in the eye. These therapies, delivered via injection into the eye, can reduce existing edemas (swelling) and reverse newly formed, pathological blood vessels in the choroid.¹ This allows photoreceptor cells that haven’t been fully damaged to be preserved, helping to halt progressive blindness and, in some cases, improve visual acuity.¹ Conventional anti-VEGF treatments necessitate frequent visits to the hospital or office-based ophthalmologist for injections, placing a considerable burden on both patients and their caregivers.¹ The high frequency of injections can also pose challenges to long-term treatment adherence, potentially affecting patient outcomes.¹

Treatment options with extended intervals can significantly alleviate the disease burden. Fewer injections and hospital visits, thanks to the extended intervals, cater to a critical patient need, enabling more time for what truly matters to them.¹

PDT- Photodynamic Therapy

PDT works by using a light-sensitive medicine called verteporfin that activates when hit by a specific type of laser. Your doctor will shine the laser on a very small area in the back of your eye, causing the verteporfin to break down the blood vessels that are causing your vision loss.^5,6,7

Bayer is committed to improving treatment options for the benefit of patients in need.

References

Khachigian LM, et al. J Transl Med 2023;21:133.
Morris B, et al. Postgrad Med J 2007;83:301–307.
Welp A et al., editors. Vision for Tomorrow. Washington (DC): National Academies Press (US); 2016 Sep 15
Ref: Likhar N et al. Value In Health 2015
Neil M. Bressler, Susan B. Bressler; . Invest. Ophthalmol. Vis. Sci. 2000;41(3):624-628.
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration/treatments-wet-amd-advanced-neovascular-amd
Cruess A et al. . Acta Ophthalmol. 2009 Mar;87(2):118-32

Click here for Bayer Ophthalmology website

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