Diabetic eyes


#1

Had an exam by my Optho in June 2016 and no Retinopathy was seen. On January 9, 2017 I woke up with floaters and blurred or distorted vision in the right eye. I followed up with the Optho who was covering for my Optho because it was a weekend. I was ask if my Optho had ever told me that I had Retinopathy. I said no. He then told me he saw bleeding in the Retina a suggested that I see a Retina Specialist, which I agree too. After I met with the Retina guy he told me that I definition had PDR in the right eye and also in the left eye, but it was at a milder stage. He has done Laser on the right eye and I have seen something improvement. He will also do some Laser surgery on the left eye tomorrow. My question is should my normal Optho have seen the diabetic signs six months ago in the right eye that I suffer the on-set in.or does diabetic eye develop that quick.

Just curious,
Bob


#2

I think yes, the optho should have detected changes and discussed with you. It’s normal for changes to occur and be seen, long before laser is required. Did your optho take photos? Did he have an older practice that may not have most updated equipment ?

Not sure if still here, but this site had a good video of live interview with retina specialist.


#3

when I had my first hemorrhage 30 some years ago, I had recently seen my regular eye doctor. of course this was along time ago, so things could be different now.

here are 2 videos we had with retina specialists, both very good
http://www.tudiabetes.org/video/tudiabetes-live-interview-with-retina-specialist-randall-wong-md/
http://www.tudiabetes.org/video/tudiabetes-talks-episode-2-arshad-khanani-retinopathy-specialist/


#4

MM1, thanks for your response. I thought is was strange that no sign at all had been seen in my right eye at the time of my annual exam. To make matters worst my while my Optho has dilated my eyes before he didn’t dilate my eyes this time, but only looked at the back of my eyes with his handheld light. I must admitted that I wasn’t paying a lot of attention and didn’t ask that my eyes be dilated for him to get a better look into the eyes, but I am not the doctor, lol. I Optho is consider to be one of the better Optho in my area, but I feel he really let my down at the time I most needed him. This is certainly not the first time that I have been disappointed my a doctor and I am sure it will not be the last. I am sure he is getting the follow-up reports from the Optho that found the problem and my Retina Specialist. I hope he enjoys the read and will do better with other diabetic patients in the future. Needless to say, but he will be fired.


#5

A couple of years back, we had a live interview here with Randy Wong, a retina specialist who is also a TuD member. He recommended that everyone who has lived with diabetes for any significant length of time undergo a fluorescin angiogram, a simple test that allows a far more detailed inspection than the normal eye exam can provide. A regular optho doesn’t normally do these tests; you need to see a retina specialist.

That prompted me to go have one done. Fortunately there was no indication of retinopathy, and now I have a benchmark on file to compare to as time goes by. I expect to do this every few years henceforth.


#6

David, I certainly agree with your assessment and your follow up to have a fluorescin angiogram test. I listen to the interview with Dr. Wong and enjoyed it. I believe my Optho like me had fallen victim to the fact that he had been my doctor for 26 years and couldn’t believe that he had not seen any Diabetic disease in my eyes. That alone should have maybe suggested that a fluorescin angiogram might have been in order for me. I can’t just go and have test without a referral or my insurance will not pay. I try to be a partner with my doctor when dealing with my health issues, but some are more receptive to my input and some are not if you no what I mean. Thanks to all for the information and have a good sugar day.

Bob


#7

What is the perceived benefit of the angiogram? I understand it could detect changes sooner, but are there early treatments that would be initiated as soon as changes are detected with it but presumably long before conventional exams would detect them? (I can’t watch the videos currently so sorry if that’s already covered in them)


#8

Even if no treatment is immediately required, having early detection can help in 2 ways. Motivation for improving control and a baseline to measure progression or confirm progression has stabilized.

Also helpful when going to different doctors, to bring images of past.


#9

@Sam19 the biggest benefit to a fluorescein angiogram is to have bright yellow pee for two days. So bright that it practically glows in the dark :smile: I compare it to a yellow light sabre in the star wars movies.

Actually the real answer is to have a baseline photos in case retinopathy starts to develop so you can see if it is getting worse. I would expect you get one done and then don’t get another untill something is detected.

I had one tiny bleed in my eye last year that they are watching on an annual basis. It is not getting worse but the photos help inform the retina specialist of what my eyes looked like in the past to compare it to.


#10

I still don’t really understand the benefit… if no treatment would be initiated until the point that they could see the problem by less elaborate and less expensive exams anyway…


#11

As mentioned the fluorescein angiogram basically shows changes MUCH MUCH earlier than what is “visibly” seen in a slit lamp exam… by the time you can “see” changes, it’s no longer early, and is in fact fairly advanced. I had a full dilated eye exam last April after a sudden loss in my visual field, and was diagnosed with a BRVO but no visible “diabetic changes” and referred to a retina specialist to investigate the BRVA. A fluorescein angiogram confirmed I did indeed have a BRVO and showed that I also have several micro-aneurisms in one eye - which means I was officially diagnosed with the earliest stages of retinopathy because it had to be accurately charted that way. The BRVO resolved on it’s own in just a few weeks (I was recovering from severe anemia and had very elevated platelets at the time, and my doc suspects that contributed to a small blood clot forming and causing the blockage in one of those super tiny vessels) before we had to discuss any kind of intervention (which is, ironically enough, would have been the exact same injections they use to treat retinopathy - it stops the development of new fragile blood vessels, which is effectively what retinopathy is - if the BRVO had remained long enough, there’s a risk that the body working to try to “fix” things will start to create new circulation).

Now, my retina specialist reassured me REPEATEDLY that what he was seeing was not exactly unexpected after 15 years with T1D, but actually not at a stage when most people were diagnosed (because it’s usually much more advanced - he was actually almost excited when telling me all of this - I got the impression I was not at all like their typical patient), and really not any cause for concern at this time as long as I maintained good control (I do) and that at this stage the ONLY thing we need to do is keep a close watch out for any future changes, and of course to call ASAP if I noticed any sudden changes in my vision.


#12

So I didn’t get retina care until I had a vitreous hemorrhage, and it seems like other people have had that experience as well. It seems likely that if my retinas had been monitored prior to that, I might have received some therapy earlier on (especially since they saw enough retinopathy in the eye without the hemorrhaging to do some laser there too). If I’d done that all earlier, who knows, might have prevented the several months of repeated hemorrhaging until it got mostly back under control. Having blurry vision in one eye really sucks and can have a surprisingly profound impact on general cognitive function in my experience. So yeah, I’d strongly recommend preventative imaging.


#13

I have had two fluorescein angiograms. I had the first one after several years of treatment with lasers and more injections in both eyes than I can count. This was done prior to a particular treatment. The concern was that if I had developed proliferative retinopathy the treatment would be useless. This allowed them to determine that it was appropriate to go ahead.

Then a couple years later I had another one. I had changed to a new doctor and practice so they wanted to have another look to compare to my first one. Everything was still okay.

One thing to keep in mind about early detection is that it can reduce or eliminate the need for more aggressive therapies. After all of the treatments I have had I am seeing much better. I am still 20;250. Some of the aggressive treatments such as laser can cause collateral damage. This damage is permanent. Having injections of various medications (steroids) leads to the certain development of cataracts. Which I have also had surgery for. Pretty much all of that could have been avoided if I would have been more aware and sought out appropriate treatment earlier.

I have had pretty much everything done to my eyes that they can do. I recently have gone to bilateral injections every eight weeks. This had been happening every four weeks for over a year. I’ve also had three vitrectomy’s. I say all this to offer support to anyone who is concerned about what to expect. I am more than glad to share my experience with anyone here who thinks that it may be helpful.


#14

You’ve only had diabetes for 7 years and have been through all that with your eyes? That’s alarming… why do you think the rapid complication?