Diabetes is bad news for the eyes

On the front page of its Science Times section, the New York Times (6/16, D1, Rabin) reports, "Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia." In fact, the "evidence is so plentiful that some experts consider moderate drinking...a central component of a healthy lifestyle." But skepticism abounds because apparently no one has "ever proved a causal relationship between moderate drinking and lower risk of death -- only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy." There are also concerns about "the financial relationships that have sprung up between the alcoholic beverage industry and many academic centers, which have accepted industry money to pay for research, train students, and promote their findings." In light of these things, some are calling for "a large, long-term randomized controlled clinical trial, like the ones for new drugs." (courtesy AOA)

If you have diabetes get your eyes checked.

In a medical column in Florida's Palm Beach Post (8/17), Andrew A. Moshfeghi, MD, of the Bascom Palmer Eye Institute, explained, "The longer you have diabetes, the greater your risk of developing diabetic eye disease, which is the leading cause of blindness in young and middle-aged adults." Dr. Moshfeghi pointed out that "diabetic eye disease" may include "diabetic retinopathy -- damage to the blood vessels in the retina," as well as glaucoma and cataracts. He provided tips for patients with diabetes to "promote good eye health," including eating well, maintaining "a healthy weight," getting "regular physical activity," taking medicines as prescribed, monitoring "blood sugar daily" and keeping "daily blood sugar less than 140," quitting smoking, and getting "a dilated eye exam once a year." Eye examinations are particularly important, he wrote, because "finding eye problems early and getting treatment right away will help prevent more serious problems later on."

A new link between Diabetes and Eye disease

Rancho Cordova, Calif., July 14, 2009 – A recent study conducted by VSP® Vision Care and the Columbus Research Foundation (CRF) showed that 98 percent of study participants who had a grayish-white ring around the cornea, an eye condition called corneal arcus, also had metabolic issues related to diseases such as diabetes, high blood pressure or high cholesterol which can lead to cardiovascular disease.

"This study demonstrates how important innovative approaches to healthcare are, and how comprehensive eye exams should be used as a screening for prevalent metabolic conditions," noted Dr. Steven Leichter, Medical Director of CRF. “Greater partnership between relevant healthcare providers may enhance the efficiency of our healthcare system and, in the end, reduce healthcare costs."

The study conducted in partnership with the CRF between April and September, 2008 with 2,000 patients, aimed to show the benefits of early detection through eye exams in overall health. In addition to an eye exam, VSP eye doctors screened patients for other health risks and referred at-risk patients to the CRF for diagnosis and additional testing.

“When you take into consideration that only 21 percent of adults receive a preventive health exam annually, while 61 percent of American adults with vision coverage receive annual eye exams, vision care plays a crucial role in the early detection of chronic diseases,” said Susan Egbert, Director of Utilization and Quality Management, VSP Vision Care.

Until now, health professionals have assumed that the occurrence of arcus is related to high cholesterol. However, this study shows there is a newly discovered and even stronger relationship between arcus and high fasting blood sugar that needs to be explored further. In fact, follow-up testing for patients who had arcus showed that:

* Eighty-eight percent had high fasting blood sugar.
* Forty-five percent had an elevated hemoglobin A1c.
* Sixty-six percent had an elevated body mass index.
* Sixty-four percent had high blood pressure.
* Twenty-one percent had elevated LDL cholesterol.

“Through this collaborative study, VSP Vision Care has found a breakthrough that will improve the lives of millions of Americans by connecting eye diagnostics with overall health, showing the numerous benefits of eye exams and early disease detection,” said former House Speaker Newt Gingrich, founder of the Center for Health Transformation (CHT). Gingrich and the CHT facilitated the partnership between VSP and the CRF through their Georgia Project.

In addition, at-risk patients with a vision related concern who were referred to the CRF kept their appointments 100 percent of the time. At-risk patients, who had no vision related issues, only kept their appointments 54 percent of the time. This study reaffirms that vision is a strong motivator for patients to seek additional health screenings and medical care to better manage their chronic conditions. Source

Diabetes treatment may help cut vision loss

Bloomberg News (7/28, Ferrer) reports that, according to a study published July 27 in the Archives of Internal Medicine, "type 1 diabetics cut their rates of vision loss, kidney damage, and heart disease when they maintained long-term, intensive insulin therapy." In fact, "patients who got three or more insulin shots per day reduced their incidence of eye damage to 21 percent compared with 50 percent of the conventionally treated patients, who got one to two injections daily," while "rates of kidney damage dropped to nine percent from 25 percent with the intensive therapy." To reach these conclusions, researchers from Harvard Medical School followed 1,441 patients from three studies.
"Long-term follow-up of clinical trial participants who got intensive therapy that's now considered standard care revealed that 21 percent developed proliferative retinopathy, nine percent had nephropathy, and nine percent had cardiovascular disease after 30 years with type 1 diabetes," MedPage Today (7/27, Phend) reported. And, "in the same trial, standard therapy circa 1983 yielded long-term complication rates of 50 percent, 25 percent, and 14 percent, respectively." MedPage also noted that "intensive therapy has gotten a bad rap recently in type 2 diabetes in trials such as ACCORD and the VA Diabetes Trial in which treating to a target under the standard seven percent showed no cardiovascular benefit and increased mortality." The study authors pointed out that "the reason for the mortality risk is still under debate, but there's no such concern in type 1 diabetes."

Diabetes can cause retinopathy

MedPage Today (6/11, Phend) reported that, according to a study presented at the American Diabetes Association meeting, "retinopathy now affects more than a third of all diabetes patients." Jinan Saaddine, MD, MPH, of the CDC, and colleagues found that the prevalence of diabetic retinopathy in "349 participants age 40 and older who had self-reported diabetes" was 34.3 percent and appeared "to increase across racial and ethnic groups between the 1988-1994 and 2005-2006 iterations of the National Health and Nutrition Examination Survey," with "non-Hispanic blacks" having "the highest prevalence of diabetic retinopathy, and the greatest increase." The investigators said that "duration of diabetes" was "one of the major risk factors," with "every five additional years of diabetes duration" increasing "the odds for diabetic retinopathy by 60 percent." Other risk factors included "male sex; higher severity of diabetes, indicated by use of insulin and oral diabetes treatments versus pills alone...or use of pills alone versus no treatment; higher average systolic blood pressure," and "higher hemoglobin A1c." (courtesy AOA)

Controling diabetes helps with complications

HealthDay (5/20, Thompson) reported that new research demonstrates the importance of "keeping blood glucose levels at a normal, low level" when "it comes to avoiding the complications of" diabetes, "which can include eye, kidney, and nerve damage." For the study, Swedish researchers analyzed "patient records at diabetes clinics in Sweden and also" included data from "a large American study." By using "new statistical methods" to analyze "the large amount of data," the team found it "possible to study the treatments' effectiveness over long periods of time." Study author Marcus Lind, MD, who presented the study, stated, "Our results show that the risk of complications 10 to 15 years after the start of treatment probably decreases significantly following even small improvements in blood glucose control." Dr. Lind continued, "If the treatment of all Swedish diabetes patients could be even slightly improved, we believe that tens of thousands of cases of injuries to the eyes, kidneys, heart, nerves and brain could be prevented."

Don't loose sight of Diabetes

Diabetic retinopathy can lead to blindness. In fact, it is one of the leading causes of blindness in the USA. High blood sugar can damage the tiny blood vessels in the back of the eye called the retina. The vessels can bleed and leak and sometimes grow new, fragile vessels. These new blood vessels can form scar tissue increasing the risk of retinal detachment.

Common symptoms may include fluctuating or decreased vision. Diabetic retinopathy is diagnosed by an optometrist during a dilated eye exam. It is recommended that everyone who has diabetes obtain a yearly dilated exam.

There are two types of diabetic retinopathy: nonproliferative and proliferative. Retinopathy will often begin in the nonproliferative stage and move on to the proliferative. When the retinopathy has reached the proliferative stage the risk for major loss of vision increases dramatically.

Today I saw a diabetic patient. I noticed a number of small hemorrhages(broken blood vessels). There was a collection of yellowy spots on her retina which was a sign that her blood vessels were leaking. When we checked her blood sugar it was far above normal for a screening. She has a risk of losing her vision if she cannot control the diabetes.


The best treatment for diabetic retinopathy, especially in the early stages, is blood sugar control. In later stages laser treatment may be necessary to control the growth of blood vessels.

Prevalence of Diabetes

UPI (1/28) reports, "Nearly one-third of U.S. adults age 65 and older have diabetes, while an additional 30 percent have pre-diabetes," according to the 2005-2006 National Health and Nutrition Examination Survey published in Diabetes Care. The survey "also found 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed."