you nailed it. I became diabetic in 1958, when needles were stainless steel, thick, re-usable. Syringes were glass. I don’t think they even knew about A1C back then. We used urine test sticks, which was about as accurate as just guessing, since there is a time delay of hours. Took the same amount of insulin no matter what the tests showed, unless there was ketones in the urine, then a boost of Regular insulin. I could feel how I was way before glucose got to the urine.
Diet was terribly crucial. Eating at the same time every day. Diabetics were dying at the age of 45-55. Living to 70-80 was a pipe dream. Blindness was common, as was nephropathy and neuropathy.; in fact, were it not for laser treatment, I would probably be blind today. I never saw an endocrinologist till I was in my teens, and that was for being a research guinea pig.
I don’t know if detection bias matters in the case of diabetic retinopathy, because it always leads to partial and full blindness if unabated. At least that is what I was taught before the days of laser surgery.
Actually, my understanding is that early detection and treatment can make a world of difference in outcomes. My “eye guy” (Randy Wong) has lots of information on website. I have my next ophthalmology appointment is actually tomorrow. He is aggressive and looks carefully for any emerging retinopathy and treats it.
A new retinopathy position statement from the American Diabetes Association (ADA) reflects the “dramatic” improvements in both assessment and treatment in the 15 years since ADA’s last guidance on this diabetes complication.
Published online in Diabetes Care on February 21, the statement covers the natural history of diabetic retinopathy, including risk factors, and reviews the stages — from mild nonproliferative to moderate nonproliferative with macular edema, to severe nonproliferative.
The document also summarizes recent data on screening and treatment with recommendations given for both and includes a discussion about cost-effectiveness.
Recent improvements in evaluation include the widespread adoption of optical coherence tomography for assessing retinal thickness and intraretinal pathology and wide-field fundus photography to detect clinically silent microvascular lesions.
And advances in treatment include intravitreous injection of anti–vascular endothelial growth factor (VEGF) agents for both diabetic macular edema and proliferative diabetic retinopathy.
“Diabetic retinopathy diagnostic assessment and treatment options have improved dramatically since the 2002 American Diabetes Association Position Statement.…This position statement incorporates these recent developments for the use of physicians and patients,” write lead author Sharon D Solomon, MD, an ophthalmologist at the Wilmer Eye Institute of Johns Hopkins Medicine, Baltimore, Maryland, and colleagues.
Senior author Thomas W Gardner, MD, professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan, Ann Arbor, says that diabetic retinopathy is "the most common cause of new cases of blindness in adults who live in developed countries and are between the ages of 20 and 74.
“Over the past decade, new research and significant improvements in technology have aided our ability to diagnose and treat diabetic retinopathy, and advances in medications are giving people with diabetes the opportunity to improve glucose management and potentially avoid or delay the progression of complications such as retinopathy,” he notes in an ADA press release.
Optimize Blood Glucose, Blood Pressure and Lipids to Slow DR
For starters, the new statement advises optimization of glycemic control, as well as blood pressure and serum lipids, to reduce or slow the progression of diabetic retinopathy.
Screening via dilated and comprehensive eye exam by an eye specialist should begin within 5 years after onset of type 1 diabetes and at the time of diagnosis of type 2 diabetes. And women with preexisting diabetes who are planning pregnancy should be screened prior to becoming pregnant, or if that doesn’t occur, during the first trimester.
For patients with either type of diabetes, if no evidence of retinopathy is found, follow-up eye exams can be scheduled about every 2 years. But if any retinopathy is identified, subsequent dilated-pupil retina exams are advised at least annually, and more frequently for those in whom the retinopathy is progressing or sight-threatening.
Pregnant women — or those planning pregnancy — with preexisting type 1 or type 2 diabetes should be counseled about the risk of development and/or progression of retinopathy during pregnancy, and they should be monitored each trimester and for 1 year postpartum as indicated by the degree of retinopathy.
Laser photocoagulation is still the mainstay of treatment for patients with high-risk proliferative diabetic retinopathy and for some cases of severe nonproliferative retinopathy.
But today, intravitreous injections of anti-VEGF are indicated for central-vision-involved and sight-threatening diabetic macular edema, Dr Solomon and colleagues say.
And the presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, since data suggest that aspirin doesn’t increase the risk for retinal hemorrhage, they note.
Nancy Matulis
ACB Maine member
CCLVI member, Legislative Committee
ACBDA member,Membership Awareness Committee
I’ve never had one of the angiograms, but my retinal specialist has started doing OCT scans each year. They are non-invasive - I thought they were just taking regular photos for the first year or two! The problem I have is that the automated machine doesn’t work on me, so it’s quite a process to get images. But the technology to actually show layers of the retina, detachment, scar tissue, and so on is amazing if you ask me! I recently saw my ophthalmologist and, knock wood, no signs of diabetic retinopathy after 25 years.
Yep, I tell them the same thing! Between dragged maculas from ROP, nystagmus, cataracts, and fairly low vision, the automated machines can never “lock on” and getting any type of image/reading from any of these machines you look into is hugely difficult. I spent half an hour with them at my resent appointment and I actually laughed aloud at one point because the lady was giving a running commentary under her breath. She was so patient, but her tone of disappointment after trying for fifteen minutes to find my macula and then losing it was priceless. Finally she gave up and told me she couldn’t do a re-examination of the same areas and would just take images from scratch. They turn out blurry even then, but my ophthalmologist is able to get some useful information from them.
I have vision in both eyes, though quite low, and I have one eye that’s definitely stronger than the other. But I’m fortunate in that I’m a dual media user, so I know (and use daily) braille, cane, screen reader in addition to low vision aids. So losing vision would be fairly easy, comparatively speaking. Blindness is definitely the diabetes complication I fear the least.
I know that all Optho are not the same, but I hope you do not fall victim to my recent situation. I have been T2 diabetic since 1989. I was a good little boy and had eye exams every year and let me add that I thought very highly of my Optho. However, I just recently had an on-set of Retinopathy and now receiving laser treatments to repair the damage. Things are coming along pretty good, but I am not out of the woods yet. Now, let me share my experience with you and others. I to was always told by my Optho after my eye exams that NO signs of Diabetic Eye was found and I will see you and those gorgeous eyes next year. Less then six months passed before I found myself in the Retinal Specialist office listening to his diagnosis of my problem. Now for the fund part. The specialist ask me if I had every been told that I had Diabetic Eye, and I answer NO, because I was never told by my Optho that I did. Naturally the specialist shocked he did sent his report to my Optho. It bother me how I went from no signs of Retinopathy to full blown Retinopathy requiring laser treatments in both eyes in less then six months. So, I requested my exams records for my last three annual exams from my Optho. I can’t explain what I saw in the reports based on what he had told me at each of my visits to his office, but here goes. First, the last exam report showed that I was dilated and that was not true. I know when I get dilated and that didn’t happen had my last exams. Regardless of that the next thing I saw in my last two eye exam reports was that I had MILD NPDR IN BOTH EYES, and a reference to a DOT HEMORRHAGE, surprise. I hate to say this but I believe that my records were changed after my Optho office received the report from the Retinal Specialist or that my Optho lied to me about what he found during my exams. I am sure that you or others who have Retinopathy can share some explanation of my sudden on-set of my Retinopathy, but I can’t. So BEWARE, and you may want to get copies of your exams. I know strange things can happen, but I truly don’t know what to believe at this point and I am still working through it.
What happened to you is precisely why I didn’t take my optho’s word that everything was fine, but preemptively insisted on seeing a retina specialist. He didn’t really want to make the referral but I forced the issue.
I hear what you are saying and I may have done something different had I been told the truth, if there was a truth to be told. It is really sad that as hard as I have worked to control my diabetes to be screwed by my Optho. Oh well, watch out folks and as David said beware especially if you have had diabetes for several years. My problem was I trusted my Optho and thought very highly of him.
I also trust mine and think highly of him. But at the end of the day, I am the one with skin in the game; no one else. They are my eyes and I will never hesitate to take whatever precautions seem right to me, without waiting for someone else’s approval.
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