Retinopathy

The studies of retinopathy risk clearly show that the risk rises with increased blood sugars. But it also shows that there is still an increased risk for diabetics compared with non-diabetics even with perfect blood sugars. There just seems to be something about having diabetes.

ps. And there are variouos causes of microaneurysms including hypertension (which could also be cause if you do things like heavy lifting)

My sympathies. It's worth bearing in mind that this sounds very mild for now. And I would want to get a second opinion from an opthalmologist who specializes in retinal disease. And keep in mind that while diabetes can raise the risks, non-diabetics get these conditions, too.

Finally, optometrists are often too lazy to test beyond 20/20, but I suspect your vision is significantly better. The theoretical limit of human vision is 20/8, 20/20 is sort of an arbitrary standard that defines what a normal person should be able to achieve. At my most recently exam, I measured 20/15 with both eyes, and I was close to getting 20/10. Growing up I was always the kid with crazy acute vision.

I'd been "clean" for a while then a couple of years ago, the doc at LensCrafters,an optometrist, found a bleeder, just one. I was like "eek" but also asked "do you know what an ophthalmologist would do for that?" and she said "nothing" so I figured I'd just wait a year and do the specialist later. Next year, I went to the ophthalmologist who found 3 "bleeders" and said "if there were like 100, we'd consider doing something, lasering them but for now, we wait and monitor it..." so that was about it. I'm older (47) and have had T1 longer but I figured it was inevitable. So now we wait.

I was hoping you’d chime in, I remember when you first posted about your LensCrafters appt. sounded like a similar scenario to my own. Wait and see. Band hope it doesn’t cause more headaches with my job license. Doubtful it will since vision is still fine but I am sure the powers that be will love to harass me about it and make me jump through a million hoops.

I out of curiosity were both your exams using the retina scan photos? I’m wondering I this had been there for years but the expert eyes disregarded it as insignificant wheras the wavelength filtered camera makes it look more alarming

Sometimes dropping your A1c fast can cause some eye damage also, you could be seeing the tail end of things getting better...your next visit could be perfect.

I would recommend that you stick with a doctor that has modern equipment and can take photos of your eyes every year and look back to see if there is some type of progression. You have 20/20 vision your fine...my brother is a pilot, 69 years old and is insulin dependent...he is required to see his Endo and flight doctor every three months, they can't find a reason to suspend him so he just keeps flying.

I had photos both times, and had been to LensCrafters before. I asked the Ophthalmologist if they wanted the LC pics and they said "no" so now I'm waiting for their second shot. I think the continuous eye follow-ups without actually doing anything may be sort of a regular feature of opthalmological medicine from cases at work but I'm sort of like "what's it going to be this year? 4, 5, 12, 36? Eeek!"

I've never had anyone photograph my retinas. I've only gotten exams from opthalmologists, and they universally seem to prefer just looking through their scopes, and at least so far, haven't found anything interesting on which to remark. I find the idea that optometrists use technology that helps them more easily detect retinal disease than opthalmologists a bit odd, for obvious reasons.

1 Like

That same thought process is certainly present in my mind. The ophthalmologist I had been going to see at Oregon Health Sciences University is supposedly one of the best in the northwest. (I travel over 1000 miles to see him, coincidentally-- I do business in that area from time to time). He's probably 65 years old, and old-school. Looks through his scope and says "you most certainly don't have any diabetic retinopathy" almost as if its a ridiculous question.

The optometrist is probably 30, and is right down the road (in the same building as the CARQUEST)... had all the high tech gadgets.... Came in and started lecturing me about how diabetes control is important-- then he looked at my chart and saw an a1c of 5.3 and that I rarely have BG above 120 and said, hmm, well these may disappear on their own... I wouldn't have expected to see true diabetic retinopathy with your history.

The photos he showed definitely did have two pin-point dark spots on them. Would a veteran ophthalmologist like my usual have even batted an eye at them, I don't know.

Hopefully you'll have a chance to engage a retinal specialist down the road, will be interesting to get their reaction.

I'll admit I haven't read the article in detail, but you might find it interesting in light of the discussion about ophthalmologists not using imaging: http://one.aao.org/clinical-statement/screening-diabetic-retinopathy--june-2012

I spent a fair bit of time comparing retina pictures on the internet. I'm not an expert, but my belief at this point is that the optometrist mischaracterized vitreous floaters (which I've had for years, and had been noted by the ophthalmologist, and are insignificant) as micro aneurysms related to diabetic retinopathy. Of course I'll test my theory with an ophthalmologist.

I wondered about this. I've had some vitreous detachment over the years, which isn't a big deal, though a bit odd given that I'm young-ish and not a boxer or football player or headbanger. Sounds like you may be similar.

I feel for you.!!!
Although I have been Type 1 for over 26 years,Tight control esp lately (6.0) I have never had anything come up with my eye exams or retinal photos until last year.

I got a note that said I have increased vascular growth in one eye, although the report said it was was no big deal and I could wait until next year.

I get freaky about that stuff so I went in to my ophthalmologist and he said he could see nothing in my eyes but the increased growth( compared to last years photo) of blood vessels are worry some because new ones tend to bleed more than old ones.

This year the report came back as NORMAL no comments.

SO you can not ignore the human factors in this, Get a second opinion. I was told that any minor leakage should be treated immediately so it will not lead to retinopathy.If you wait for major leakage,you may have already lost some retina.

It may be worth the drive to see a new doc just to put your mind at rest

Thanks Tim, I am planning on doing that. The more I think about it the more I feel like this examination lacked some credibility....

For one thing I had seen the same guy in 2011, a year before being diagnosed with diabetes. My complaint was that my right eye "didn't feel right" and was constantly fatigued. He did a pretty lackadaisical exam at that time, didn't dilate my eyes, no retina scan, etc--- Then told me that my vision was excellent, and there was nothing wrong with my eyes whatsoever. (he did suggest that my right eye wouldn't feel weird if I stopped using my cell phone so much)

In the three years since (post-diabetes dx) I had gotten comprehensive dilated exams from two different ophthalmologists who evaluated my entire medical history--- and also noted and described the vitreous "floaters" as such, and noted without a doubt there was no retinopathy observed--- my A1C has been in high 4s to mid 5s that entire time (after the initial stabilization)

This time when I saw this guy he had reviewed my new retina photos before he even walked in the room or looked at my information that the assistant had charted, A1C, glucose averages, etc.... and then made the assumption that he needed to scold me about controlling blood sugar control, which couldn't be further from the truth---

So basically at this point I've pretty well convinced myself that he saw the word "diabetes" and went off on a tangent when he saw a little tiny bit of irregularity in one eye, even though it was a known issue not relating to diabetes...

Who knows maybe I'm fooling myself, as you can probably tell by reading this I've put a fair bit of thought into it (some of which while lying awake in the middle of the night) but I will follow up for a second opinion with an ophthalmologist.

Had a great endo apt today. A1C was 5.2. Feel a lot better about the bizarre eye exam after talking it over with him-- he asured me that there is no way on earth I have diabetic retinopathy at this point, “it just doesn’t happen that fast, period.”

Those must have been good words to hear!

That's great news Sam! It's good your keeping an eye on it [ok, I couldn't resist...]. I hope you can find a doc with better bedside manner than Dr. Crankypants. I finally broke down and started going to an ophthalmologist last year and am glad that the one I found seems to be very sharp and is very pleasant.

Update— finally got in to see a real eye doctor today instead of an optometrist with their fancy toys. “Normal. No changes. No retinopathy.”

My endo told me not to let an optometrist do my exams in the future, only actual ophthalmologist.

2 Likes

Don’t be too hard on yourself. Your A1C’s have been excellent. The issue though is that no matter how vigilant you are, you will have blood glucose fluctuations that non-diabetics don’t have. I’ve had Type 1 for 32 years, and although thankfully my ophthal tells me each year that my eyes look good, he admits they still show evidence of diabetes. You don’t say if you’re T1 or T2, but the reality is that by the age of 40, virtually all T1’s show at least some minor retinopathy. It’s an extremely common complication along with kidney damage, both of which are very frustrating. So keep up the good work and take your doc’s feedback to heart, sounds like your eyes are still in very good shape.