Retinopathy


#1

I heard an opthamologist on tv saying everyone who has diabetes will get diabetic retinopathy eventually. Have you heard this? Nancy


#2

I have heard it said also. Not at all sure I believe it.


#3

i guess that people who follow ada guidelines on blood sugar control would eventually get complications, retinopathy being one that is particularly sensitive to even modestly raised blood sugars.

i would also suggest that by maintaining right control and normal blood sugars, it may not be inevitable.


#4

Well, 21 years now and the optho says he sees no trace of it. The retina specialist who saw me a couple of years ago said the same.


#5

I’m not basing this off any actual medical knowledge, but I would think that statement to be incorrect. Firstly, it’s like stating everyone who smokes will get lung cancer. Yes, you may but it’s not guaranteed.

Secondly, perhaps this is different in other countries, but at least in Australia unless you have another eye condition as a diabetic you would only see an ophthalmologist if your optometrist picked up abnormalities or signs of retinopathy. Given this, it would be logical that an ophthalmologist would conclude that all diabetics would get retinopathy, as this is what they know.

I’d be more interested to see how many Endocrinologists, or primary care physicians said the same thing? My guess would be not many.

I’d also suggest that perhaps all diabetics may get some minute signs of retinopathy, but as far as I understand it non-proliferative retinopathy isn’t really problematic. I’d leave that up to your specialists to comment on that further though.


#6

I don’t think this is true. I went to a new opthamologist last week for my annual dilated eye exam. It’s been over 32 years since my T1D diagnosis and I believe I had diabetes for a year or two before my diagnosis. I received a great report from him. He said he had to look real hard to even find one instance of evidence of diabetes in my eyes. I told him that I knew I was lucky that some of my genes protected me from this complication. He seemed to think that maintaining good blood glucose was more of a factor than genes.

I think that genes do play some role here. Otherwise, why would some people with few years of diabetes receive this complication diagnosis? The Diabetes Complication and Control Trial (DCCT) told us that keeping BGs in a reasonable range mattered with retinopathy incidence. I do believe that. But I’ll take good genes any day.

I don’t believe the TV opthamologist was right. He’s not right in my case and I don’t think I’m the only one with my fortunate experience. The DCCT tells another story.


#7

My dad has been T2D for about 20 years now and has poor control (A1C >7). Weirdly, he is going blind from an inherited disease called retinitis pigmentosa and glaucoma, but no signs of retinopathy at all. So clearly not everyone gets it (Though in his case it sort of wouldn’t have mattered anyways).


#8

Things have changed a lot in the past 40 years with the introduction and wide use of home bg monitoring and increased effort by diabetics and their health care providers to maintain bg averages near normal.

For example, in the 1980’s, it actually was true that most all T1’s would have retinopathy within 10 years of diagnosis. I believe I saw this published in WESDR results back then.

Today, thanks to the DCCT and a widespread effort to self-monitor bg’s and adjust insulin doses accordingly, bg control is far far better than back then and the resulting retinopathy rate far lower. It is still way bigger than zero. A recent WESDR result now puts it at 39% chance of some kind of retinopathy within 10 years. That’s still a large complication rate BUT it reflects so much progress in the past 30 or 40 years. You newbies don’t want to know what it was like 40 years ago. Stone Knives and Bearskins.


#9

I had an opthamologist tell me that I was doing great to not have any signs of diabetic complications after 15 years or so as a T2D. But then he said “But it’ll happen eventually.”

He’s no longer my opthamologist.


#10

Thanks,I have had type 2 for 24 yrs,good control. No signs of it yet but I do have a congenital eye ( retina) disease. ) No signs of issues from diabetes. Nancy


#11

I know patients having had T1D for their whole life and had no sign of diabétic retinopathy, nor any other complications.


#12

we had a retina specialist here a few years ago who did say it is probable you’ll develop retinopathy eventually if you live w d a long time

http://www.tudiabetes.org/video/tudiabetes-live-interview-with-retina-specialist-randall-wong-md/
around minute 6 or so.

luckily, it can be treated, but we need to do our best to keep our blood sugars in range and to get a dialated exam once a year.


#13

This highlights one of the (many) difficulties we face with the professions. Too many HCPs are “frozen” in the knowledge they acquired in school, when it may have been up to date, and haven’t stayed current with a rapidly evolving field. Not all, of course. But still too many.


#14

The revolution started in the mid-90’s with the early published DCCT results. Obviously it’s not made an impression on every single doctor out there - but there has been so much progress in my third of a century with T1!


#15

Just curious about how many of you all claiming “no” retinopathy have actually had a FULL workup by a specialist including a retinal angiogram? Shining a light in your eyes with a magnifier is not all that effective in diagnosing the very earliest signs. By the time there are visual signs that a doctor can see by just looking, it’s pretty far advanced…


#16

Is there a point to more advanced screenings? Is there a treatment that can be initiated that early on that will help? Or are people just paying a great deal of money to be told they have a problem?


#17

My impression is that a good opthamologist, doing a dilated eye exam with a slit lamp, can see retinopathy before the fancy-pants cameras and laser tests see it.

I’ve been through a lot of fancy-pants cameras and laser tests and they certainly seem to have been money unnecessarily spent. My favorite is the
Optical Coherence Tomography machine - reminds me of the video game Battle Zone! The angiogram, is that where they shoot the fluorescent dye in my vein, take pictures while everything turns red, and then I pee bright orange for the rest of the day? Had a lot of those too.

It used to be every time I blinked they would waste a piece of Polaroid film in the fancy pants camera. For many years now they’re digital cameras at my opthamologists, so I don’t feel so bad every time I blink and mess up the picture! You young guys, might not remember Polaroids. (I have co-workers who visit me in my office for the first time and see my turntable and records. The young ones tell me “I saw one of those in a museum once!”)

I can see the fancy-pants cameras being useful, if they want to document the progression of retinopathy over many years, or perhaps as something to put in the medical charts for future reference as a baseline, or to pass to another specialist.


#18

I have. 21 years, not always well controlled, and the angiogram was clean. My reply stands.


#19

Your reference to a “retinal angiogram” is my first awareness of this test. After a quick internet search I discovered that a contrasting dye is used to provide a good view of the eyes. I have had photos taken of my eyes during an exam. But this was many years ago. I suspect the imaging process has improved in the years since I’ve had it done.

Do you have a link that supports this? I am not trying to be contentious; I just want to learn more. I’ve always understood that a dilated eye exam conducted by an opthamologist is the standard of care to detect retinopathy. Things change, however, and that’s one of the reasons that I interact on this site


#20

I did find this information on a National Institute of Health website. It provides as good survey of the various retinopathy diagnostic modes.

When comparing standard opthamology exams to “fundus photography,” it had this to say:

There are a number of disadvantages of using color fundus photography for screening, however. Color fundus photography is not a substitute for a comprehensive eye exam, as it cannot be used to look for other ocular diseases such as glaucoma or cataracts. Even widefield photography is not capable of imaging the entire retina. Macular edema and retinal neovascularization cannot always be visualized on fundus photographs, and image interpretation can sometimes be limited due to imaging artifacts or poor image quality. The American Diabetic Association (ADA) states that fundus photography may be used as a screening tool for retinopathy, but is not a substitute for an ophthalmic exam, and in 2014, still recommends an eye care professional evaluate all patients with diabetes.7

A meta-analysis done by the American Academy of Ophthalmology (AAO) showed that single-field fundus photography, when interpreted by trained readers to detect vision-threatening retinopathy, had a sensitivity ranging from 61% to 90% and specificity ranging from 85% to 97% when compared to 7-field fundus photos. The recommendations from the study were that there is the level I evidence that single-field fundus photography can serve as a screening tool for diabetic retinopathy to identify patients for referral to an ophthalmologist.8 As digital fundus photography continues to improve and the volume of patients with this disease increases, color fundus photography will likely serve as an important screening modality. Currently, however, dilated eye examination remains the standard of care.9 [emphasis added]

Here is a good summary taken from the NIH page:

In summary, imaging modalities for the management of diabetic retinopathy remain clinically important. Fundus photography can be used to document retinal disease over time, and may be increasingly helpful in screening of diabetic patients for retinopathy. B-scan ultrasonography can be helpful in patients with media opacity, such as vitreous hemorrhage or cataract. FA [fluorescein angiography] is helpful to visualize retinal ischemia, as well as leakage from retinal neovascularization and also in macular edema. OCT [optical coherence tomography] has become a critical tool in the diagnosis and management of diabetic macular edema. As these technologies have continued to evolve, their importance in the diagnosis and management of diabetic retinopathy has become increasingly evident.

Thank-you, @sarahspins, for causing me to learn more about this topic important to people with diabetes! I’m uncertain, at this point, that the standard of care, the opthalmic dilated eye exam, is not good enough alone to screen for diabetic retinopathy.