Living with DME? Here s what you need to know

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limitation, any fault, error, omission, interruption or delay with respect thereto.

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Living with DME?

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DME affects the retina and macula

DME: Diabetic macular edema

Reference: Your guide to diabetic macular edema. Macular society. Available [Online] at: https://www.macularsociety.org/sites/default/files/resource/Diabetic%20Macular%20Oedema.pdf Accessed on 4th June 2020

Human Eye Anatomy

Retina and

macula are vital

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Anti-VEGFs are the most effective treatment for

DME

1

AMD: Age-related macular degeneration; VEGF: Vascular endothelial growth factor Reference:1) Dervenis N, et al. Adv Ther 2017 34:1270–1282.

To slow down

disease progression

To preserve

existing vision

Immediate &

continuous treatment

essential to prevent

vision loss

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Did you know?



Adherence to prescribed treatment can reduce number of injections

required

Reference: Bressler SB, et al. Am J Ophthalmol. 2016 April ; 164: 57–68.

Year 1

Year 4

Year 5

Adherence to prescribed therapy is the key

to vision improvement!

(7)

Remember!

Well controlled

blood sugar

Well-controlled

vision

Visit your eye doctor and ensure that you

retain the gift of sight

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Reference: Urbano CA. Retinal Physician. Addressing Myths of Diabetic Macular Edema Treatment. 2019. Available [Online] at:

https://www.retinalphysician.com/issues/2019/september-2019/addressing-myths-of-diabetic-macular-edema-treatme_Accessed on 23 June 2020.

Missing or delaying

treatment can lead to

vision loss

1 Studies have proven:

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Increasing vision loss can lead

to decreased ability to perform

daily activities

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DME may impact both eyes

Impact of DME is greater when

both eyes

are involved as

compared to those in whom DME

has affected only

1 eye

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Vision loss leads to inability to perform vision

related tasks

Reference: Cooper OAE, et al. Diabet. Med. 2020;37:924–933.

Inability to read /

write /watch TV

Inability to

recognise faces

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Vision loss impacts productivity at work

Inability to use devices

over long periods

Difficulty in driving

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Vision loss increases risk of anxiety &

depression

Increased risk

of anxiety

Increased chances

of depression

(14)

Reference: Cooper OAE, et al. Diabet. Med. 2020;37:924–933

Vision loss increases

the risk of falls

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Vision loss impacts overall health

Inability to do

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Don’t let fear

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COVID -19 and DME

DME: Diabetic macular edema

Reference: 1. Gupta V, et al. Indian J Ophthalmol 2020;68:962-73

Recommended by

Treatment of DME is

considered to be essential

therapy and is given

priority even during the

lockdown with an aim to

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Doctors are committed to patient safety

Reference: 1. Gupta V, et al. Indian J Ophthalmol 2020;68:962-73]

Guidelines for Functioning of

Eye Care Facilities under

NPCB & VI By Ministry of

Health and Family Welfare 8

th

May 2020

+

Guidelines to safely

manage patients who come

to the clinic for anti-VEGF

treatments

All clinics will follow the

recommended safety measures

to ensure that exposure to

infection is minimized

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Steps to ensure

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Use telemedicine consultation

Reference: 1. Gupta V, et al. Indian J Ophthalmol 2020;68:962-73.

1. Update your doctor on your

status of symptoms

2. Agree on your treatment

plan

3. Set up an appointment for

your next treatment

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1. Update your doctor on your vision

Better

Same

Reduced

What do you notice about

your vision?

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Monitor your vision at home DAILY

References: 1. Amsler's Chart to test your sight. American Macular Degeneration Foundation. Available [Online] at:https://www.macular.org/amsler-chart Accessed on 4th June 2020. 2. Boyd K. Have AMD? Save

Your Sight with an Amsler Grid. American Association of Ophthalmology. Available [Online] at: https://www.aao.org/eye-health/tips-prevention/facts-about-amsler-grid-daily-vision-test Accessed on 4th June 2020

Amsler’s Grid:

A simple vision test –

anywhere, anytime

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Using the Amsler’s grid to monitor vision

1. Tape this page at eye level where light is consistent

and without glare.

2. Put on your reading glasses and cover one eye.

3. Fix your gaze on the center black dot.

4. Keeping your gaze fixed, try to see if any lines are

distorted or missing.

5. Mark the defect on the chart.

6. TEST EACH EYE SEPARATELY.

7. If the distortion is new or has worsened, arrange to see

your eye doctor at once.

8. Always keep the

Amsler’s Grid the same distance from

your eyes each time you test.

References: 1. Amsler's Chart to test your sight. American Macular Degeneration Foundation. Available [Online] at:https://www.macular.org/amsler-chart Accessed on 4th June 2020. 2. Boyd K. Have AMD? Save

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If you notice any areas on the grid appearing dark,

wavy, blurry or blank, call your doctor immediately

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2. Agree on a treatment plan

Your doctor will decide the frequency

best suited for you depending on:



Symptom severity

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Disease stage

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You may need injections every 3 to 4 weeks

References: : Urbano CA. Retinal Physician. Addressing Myths of Diabetic Macular Edema Treatment. 2019. Available [Online] at:

https://www.retinalphysician.com/issues/2019/september-2019/addressing-myths-of-diabetic-macular-edema-treatme_Accessed on 23 June 2020.

Regular treatment will help

maintain the beneficial

effects of the medication

It is important that you stick to the treatment plan

recommended by your doctor

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Don’t forget to adhere to your prescribed diabetes

therapy

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It is important that you adhere to

your diabetes treatment

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Uncontrolled blood sugar levels

can worsen your DME

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Call your family physician if you

have any doubts about your

diabetes prescription

Reference: Griff AM. Tips for Managing Life with Diabetic Macular Edema. HealthLine. Avialable [Online] at: https://www.healthline.com/health/eye-health/tips-managing-diabetic-macular-edema#Start-using-low-vision-aids Accessed on 4 June 2020

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3. Set up an appointment

Reference: 1. Gupta V, et al. Indian J Ophthalmol 2020;68:962-73. 2. Coronavirus and your macular degeneration care. American Macular Degeneration Foundation. Available [Online] at:

https://www.macular.org/2020/03/19/coronavirus-and-your-macular-degeneration-care Accessed on 2 June 2020

Most clinics are

functional to ensure

continual treatment of

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Continual treatment

is the key to better

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Ask your doctor about

*If you are doing at home follow the exact instructions given by the doctor

Reference: Why do I need to get my eyes dilated? WebMd. Available [Online] at: https://www.webmd.com/eye-health/why-get-eyes-dilated Accessed on 5 June 2020

Advantage: Will help

reduce the amount

of time you spend in

the clinic

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Here’s what

YOU need to do before your

scheduled appointment

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Write down questions that you would like

to ask your doctor

This will help you get the

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Decide on your ride

Reference: Seddon JM. Coronavirus and Your Macular Degeneration Care. American Academy of Ophthalmology. Available [Online] at:

https://www.aao.org/eye-health/tips-prevention/coronavirus-macular-degeneration-avastin-injection Accessed on 5 June 2020

You will need someone

to drive you to and

from your appointment.

Prefer a family member or a

trusted friend

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Safety measures while traveling

Wipe clean your car

seat, windows and

handles with alcohol

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Ensure personal safety

Reference: Sengupta S, et al. Indian J Ophthalmol 2020;68:711-24

Mandatory use

of masks and

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Be at the clinic before the scheduled

appointment time

Reach at least 20

minutes prior to your

appointment time to

ensure appropriate

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Managing your clinic visit

Your eyesight and your health are

equally important

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Sanitisation

Disinfection of

hands with

alcohol-based sanitiser on

entering the clinic

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Limited entry

Only you and one

attendant may be

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Waiting hall guidelines

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Initial screening

Submitting to initial

screening of body

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Travel related

Reference: 1. Sengupta S, et al. Indian J Ophthalmol 2020;68:711-24 2. Seddon JM. Coronavirus and Your Macular Degeneration Care. American Academy of Ophthalmology. Available [Online] at:

Have you travelled

(nationally) in the past

2 weeks

1 You may have to fill a written

declaration about your travel history

2

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Contact with a COVID-19 patient

Have you been in contact

with a COVID-19 patient or

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COVID-19 related symptoms

Have you or your family members experienced symptoms such as:



Fever

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Cough

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Breathlessness

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Loss of smell



Acute conjunctivitis

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Be assured

Cleaning and

sanitising of the

clinic, waiting area

and equipment is an

on-going process

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Be assured

All staff will be provided

with disposable masks,

gloves and PPE suits to

ensure that you are safe

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Be assured

Guidelines by

Technicians will use ‘non-touch’ method to perform

eye dilation (if required)

Patient self

retracting

lower lid

Retraction

with an ear

bud

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Do your bit to manage

DME at home

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Accidents at home may lead to severe injury

Here are some tips to stay safe at home

Take precautions to minimize the risk of falls

and injuries

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Light up your living spaces

References: 1. 16 Ways to Modify Your Home if You Have Diabetic Macular Edema. Everyday Health. Available [Online] at: https://www.everydayhealth.com/hs/diabetic-macular-edema/home-modifications/

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Lighting vulnerable

spots like stairs

Lights for better visibility

References: Tips for Managing Life with Diabetic Macular Edema. HealthLine. Available [Online] at: https://www.healthline.com/health/eye-health/tips-managing-diabetic-macular-edema#Start-using-low-vision-aids

Accessed on 4 June 2020

Movable lighting

Dim lighting at night

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Clutter-free floors

Easy navigation

1,2

References: 16 Ways to Modify Your Home if You Have Diabetic Macular Edema. Everyday Health. Available [Online] at: https://www.everydayhealth.com/hs/diabetic-macular-edema/home-modifications/ Accessed

on 3 June 2020

Grab-bars in bathroom

Railing on stairs

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Kitchen hints

References: 16 Ways to Modify Your Home if You Have Diabetic Macular Edema. Everyday Health. Available [Online] at: https://www.everydayhealth.com/hs/diabetic-macular-edema/home-modifications/ Accessed

on 3 June 2020

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Tips to manage your

productivity at work

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Technology to the rescue

1,2

References: 1. Rodriguez D. 9 Ways to Manage Vision Loss From Wet Age-Related Macular Degeneration. Available [Online] at: https://www.everydayhealth.com/hs/managing-wet-amd/manage-vision-loss/

Accessed on 2nd June 2020. 2. Dunaief J. Living with AMD: Home Safety and Reading Aids. BrightFocus Foundation. Available [Online] at: https://www.brightfocus.org/macular/article/living-amd-home-safety-and-reading-aids Accessed on 2 June 2020.

High powered

reading glasses

Magnifying glasses

Larger font options

on devices

Ask your doctor or optometrist for technology

that will help you enhance your vision

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Closed circuit TVs



These are camera’s that project an

enlarged image on your computer

screen



They can be hand-held or mounted

on a stand next to your computer

Reference: 6 Gadgets That Make Life With Diabetic Macular Edema. Everyday Health. Availble [Online] at: Easierhttps://www.everydayhealth.com/hs/diabetic-macular-edema/low-vision-devices/ Accessed on 23 June 2020

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Use low vision sun-filtered glasses

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Filtered lenses will reduce the

glare or bright light from

devices and improve your

ability to differentiate between

objects

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E-readers

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Use of e-readers will help

adjust font size, background

and contrast to a setting that

is comfortable to you

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Join the community...

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To summarise…

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Loss of vision in DME can lead to

serious problems

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Go to the clinic for your regular DME

treatment with anti-VEGF injections

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Safety assured – You will receive

your treatment in a safe

environment

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