The Eye Practice

Diabetes comes in two main types.  Type 1 and Type 2. 

Type 1 diabetes is quite frustrating for the affected person as they have to monitor their sugar level 6 - 8 times per day by taking blood samples.  This is done by pricking the finger with a needle.  What is tough is when children as young as 5 or 6 years of age have to do this every day and potentially for the rest of their lives.

In a previous post we discussed the use of a contact lens to monitor the pressure inside the eye to keep on top of a disease called glaucoma.  At Microsoft they are working together with specialized engineers to come up with a contact lens that can accurately measure sugar levels in the blood by continually monitoring sugar levels in the tear film.  Have a look at the following video.  Certainly it is a marketing video by Microsoft but the underlying message is fascinating.

Even though it is not well explained in the video, electronic circuitry will be implanted within the matrix of the contact lens, which will wirelessly send data to a synchronized computer for the patient to view, or to a medical facility that will monitor the patient.

One of the biggest issues in any medical management for a disease like diabetes is patient compliance with both monitoring and treatment.  Being accountable to your doctor, who I assume will SMS you if you are dropping off your treatment protocol is bound to be a great step forward to keeping people out of our hospital systems and leading dramatically improved and longer lives.

Who would have thought that a tiny bit of plastic that corrects blurry vision one day might be able to also measure blood sugar levels and the pressure inside the eye.

If this technology proves to be successful it is quite likely that other blood markers might be able to be measured, such as cholesterol and maybe even thyroid function and liver function. It is quite possible that the majority of the blood pathology industry could become obsolete in due course!

At The Eye Practice we have a feeling that in 10 years time we will be seeing technology implemented that we have not even dreamed about yet.

Diabetes if not controlled can affect the eyes, the feet, the kidneys, can cause strokes as well as other problems.  The best treatment for all of the associated conditions is to tightly control the diabetes but if the eyes are finally affected with diabetic retinopathy what can be done?

Significant diabetic retinopathy dramatically slows down the blood flow to the retina.  The body has an instinctive defense mechanism when it perceives that there is not enough blood flow to a given area - it creates new blood vessels to try and redirect blood, nutrients and oxygen to the starved areas.

These new blood vessels are stimulated into growing by the release of a natural chemical called vascular endothelial growth factor (VEGF).  Unfortunately these blood vessels even though they are formed for the good of the retina, tend to be very fragile and can leak or haemorrhage.  This in turn creates a vicious cycle, which causes more damage to the retina.  Left untreated it can ultimately lead to blindness.

Treatments

Historically diabetic retinopathy has been treated with laser. It is called laser photocoagulation.

The irony of laser is that it actually burns and destroys retinal tissue so that there is less demand on the blood flow to the remaining surviving retina.  Typically this restricts peripheral vision so that the central vision is spared.  Central vision is required to read, watch TV and recognise faces. 

Laser surgery can also be performed in the central part of the retina called the macula if there is leakage there.  It is done in a much more gentle fashion called focal grid laser, so again the central vision can be spared.

The most famous study that was conducted to show the benefit of laser treatment for diabetic retinopathy was performed in the 1990's.  It was called Early Treatment Diabetic Retinopathy Study and was sponsored by the National Eye Institute - NEI showed  (USA government funded to promote Eye Research).  This massive study went on to show that laser photocoagulation had a big role to play in trying to preserve the sight of people that were suffering from diabetic retinopathy.

So what is new?

As mentioned before damage to retina occurs because of fragile new blood vessels that form due to the presence of the chemical VEGF.  Wouldn't it make sense then if this chemical could be blocked, new vessels would be less likely to form and hence the retina less likely to be damaged.  This in turn would preserve vision.

A recent study again sponsored by the NEI showed that by injected an anti-VEGF drug into the eye called Lucentis on a regular basis did in fact protect eyes from the damage of diabetic retinopathy.  What was interesting was that the results were superior to laser.

The issue with anti-VEGF therapy at the moment is that ongoing injections are required to maintain vision.  Apart from being very inconvenient and costly, there is a small risk each time that a major complication could occur.

Ultimately this type of therapy is likely to be evolved into some sort of slow release implant that will be effective over a long period of time - say five years.

Treating eyes with anti-VEGF injections has become the mainstay treatment for macular degeneration now for a few years.  Surgical centres have become overwhelmed with treating these patients as many of them require injections every month.

If we add diabetic retinopathy to the system as well every month or two, treating eye disease will become an extremely labour intensive procedure.  Either more eye surgeons will need to be trained, or maybe optometrists will be trained at either the diagnostic or treatment level if slow release implants do not come to fruition. 

It might be scary to imagine having an injection in your eye every month, but what is even scarier is the thought of going blind!

Most patients will tell you that even though the injection process is not pleasant it is far from tortuous.  They are delighted that something can be done to protect their most precious sense - THEIR VISION!

At The Eye Practice we test the eyes of diabetics all the time.  We are equipped at the highest possible level to detect the beginnings of diabetic retinopathy.  We also have great working relationships with the best diabetic retinal surgeons, who we would refer you to immediately if treatment was indicated.

Call us on 92901 1899 or BOOK AN APPOINTMENT HERE for your diabetic retina check.  This should be done yearly if you are diabetic.

Diabetes mostly today is a lifestyle disease.  Obesity, lack of exercise and poor diet has created a huge issue in society.

From an eye and vision perspective a condition called diabetic retinopathy is the leading cause of blindness in an age group under 50 years of age.

What is diabetic retinopathy?

The back of the eye is called the retina.  It has a very intricate and important blood vessel system. Diabetes over time significantly impacts the ability of this blood vessel system in transporting blood and oxygen and nutrients around.  This in turn slowly will degenerate the retina, which is responsible for vision.

Diabetic retinopathy can consist of the following signs when your optometrist looks at the back of your eye:

1. Microaneurysms
2. Blot and dot haemorrhages
3. Exudates - signs of poor blood flow
4. New blood vessels at the optic disc - new vessels are created due to low oxygen supply in the retina.  The body creates thes to keep the retina functional.
5. New blood vessels elsewhere - these new blood vessels are very fragile and can haemorrhage and cause dramatic damage.
6. IRMA - Intra retinal microvascular anomalies
7. Macular Oedema - this is swelling at the macula area

Diabetic retinopathy is treatable if found in its early stages. Referral to a retinal specialist is preferable, when treatment is finally indicated.

From the signs listed above it might seem easy to diagnose diabetic retinopathy.  If it is in the advanced stages, this is probably true, but in the early stages it is important to look carefully and with the correct equipment.  It is also important to make sure that dilating eye drops have been used so that the pupils of the eyes are opened up to maximum size.

Pupil dilatation allows the observing eye practitioner to see the retina (back of the eye) significantly easier. Digital Retinal Photography and retinal scanning using instruments like Stratus OCT, Cirrus OCT or other OCTs allows more detail to be analyzed and therefore a more accurate diagnosis to occur.

Bottom line is that diabetic retinopathy indicates a compromised retina and probably the rest of the body.

Ultimately the best treatment for diabetic retinopathy is to control the diabetes as diligently as possible.  This might sound obvious but the problem is that having diabetes does not cause any significant symptoms unless sugar levels are going haywire.

From an eye perspective a yearly dilated retina examination is your best defense against this disease process.  Are you diabetic? Have you had your retina examined within the last year?

Call The Eye Practice on 9290 1899 or Book Online Now.

The Eye Practice has experienced optometrists and all the equipment necessary to get the management of your eyes right.

Diabetes is another one of the chronic diseases of our time.  There has been a significant increase in prevalence in the last 20 - 30 years in the urbanised world.  There seems to be a direct link to the increased prevalence of obesity.

Many of us have heard of Diabetes Type 1 and Diabetes Type 2. 

What is Type 1 Diabetes?

Type 1 Diabetes was originally known as Juvenile Diabetes as it developed at an early age and is thought to be an autoimmune destruction of the pancreas - possibly from a virus.  Treatment with insulin injections are ongoing although pancreatic cell transplantation is slowly developing and possibly could be a cure in the future.

Uncontrolled Type 1 Diabetes has severe overall health implications, including: cardiovascular disease, kidney disease, peripheral neuropathy (especially in the feet) and a devastating eye disease called diabetic retinopathy.

What is Type 2 Diabetes?

Type 2 Diabetes was originally known as Late-Onset Diabetes.  The renaming of of the categories is in itself an indicator that the distinction of age is no longer valid, now that obesity is so common amongst children.

Type 2 Diabetes is a metabolic disorder that more commonly occurs in the over weight and inactive population.  Originally it seemed to occur in later age because people on average tend to become less active and overweight later in life.  The tragedy now is that obesity and inactivity is now also very common in our children.  We are therefore seeing more Type 2 Diabetes in our younger population; therefore Late-Onset Diabetes is no longer an appropriate term to use.

Type 2 Diabetes does not mean that the pancreas is no longer functional.  It means the insulin that the pancreas produces is not as effective at reducing sugar levels in the body. Especially compared to someone that does not have the metabolic disorder and is of normal weight.

Uncontrolled Type 2 Diabetes also causes cardiovascular disease, which includes strokes and heart attacks. Kidney disease and poor peripheral blood circulation occur, whilst in the eye, diabetic retinopathy is the greatest cause of blindness in age group under 50.

                       NORMAL RETINA                                      RETINA WITH DIABETIC RETINOPATHY 

As far as the eyes are concerned diabetes is of great concern, especially since it is responsible for the greatest prevalence of blindness in a younger population.  The common theme amongst the chronic diseases of our society including high blood pressure, elevated cholesterol and diabetes is simply inappropriate diet and lack of exercise.  Most distressing is that all we are doing as a society is producing pills and medicines to try and suppress these problems.  Unfortunately it is a losing battle.

In future posts we will discuss diabetic retinopathy in more detail, including testing to discover it in its earliest stages and its timely treatment.