Diabetic retinopathy

New treatments can improve diabetic retinopathy’s effects on vision

 

Resources

These websites offer information on diabetic retinopathy:

Bascom Palmer Eye Institute:

http://bit.ly/1791PkQ

Diabetic Retinopathy Clinical Research Network:

http://bit.ly/HFtlv8

National Eye Institute:

http://1.usa.gov/HyILRs


icordle@MiamiHerald.com

Three years ago, Valerie Dodamead was diagnosed with diabetic retinopathy — a disease related to diabetes that can lead to vision loss and blindness.

After having laser surgery at a clinic in Broward, her left eye was damaged and she became blind in that eye.

So she went to the University of Miami’s Bascom Palmer Eye Institute, where Dr. Harry Flynn told her she was a perfect candidate for a new treatment for her right eye.

Over the past two years, Dodamead has undergone 24 injections in that eye, and her vision, once 30/50, has been restored to 20/20.

“The thought of having a needle stuck in my eye was really scary,” said Dodamead, 68, who lives in Northwest Miami-Dade. “ ‘You are going to stick a needle in my eye?’ There was a great hesitation, but he said, ‘It will work on your eye and you will go blind in that eye, it is just a matter of time.’ I have two grandbabies and I want to watch them grow up, so I said, ‘I’m going to do it.’ ”

Now she recommends the treatment wholeheartedly.

“Once you do it, there’s nothing to it,” she said. “The end result is the most important thing: I can see. I can see my two grandbabies, I can see my husband and work in the yard and see my flowers and see my blue jays, and that is what life is all about.”

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults, according to the National Eye Institute.

Anyone with type 1 or type 2 diabetes is at risk, and the longer someone has diabetes, the more likely he or she will get diabetic retinopathy, the NEI said. In fact, between 40 to 45 percent of Americans diagnosed with diabetes have some state of the disease, the institute said. It usually affects both eyes.

“Diabetic retinopathy is the No. 1 cause of legal blindness in working-aged Americans,” said Flynn, a professor of ophthalmology at Bascom Palmer.

The disease is caused by abnormal blood vessels in the retina that undergo leakage or hemorrhage, ultimately resulting in reduced vision.

Flynn said it generally occurs among diabetics in their 40s and 50s.

“If a person has had diabetes for 20 years, the rates of retinopathy are relatively high,” said Flynn, who joined the faculty of Bascom Palmer 35 years ago to run clinical trials for new treatments for diabetic retinopathy.

For 10 consecutive years, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine has been ranked No. 1 nationally in ophthalmology in U.S. News & World Report’s annual “best hospitals” rankings. It is the largest ophthalmic care, research and educational facility in the southeastern United States.

Flynn said that sometimes an ophthalmologist is the first to diagnose the effect of diabetes in the eye, even before a patient knows that he or she has type 2 diabetes.

That’s because the blood vessels can start the leakage and the abnormalities before the patient loses vision or before the patient has any symptoms.

The effects of diabetic retinopathy can be slow and subtle — or rapid and profound, he said.

“Early recognition and early treatment are often associated with better outcomes,” Flynn said. “There is no cure, yet our treatments have improved in recent years.”

Treatments for diabetic retinopathy include laser, pharmacotherapies — treating with drugs – and surgery.

In the late ’70s and early ’80s, clinical trials centered on laser therapies, and laser treatments are still the gold standard for diabetic retinopathy, he said.

But more recently, pharmacotherapies — like the injections Dodamead received — have become the new standard.

“Once you do the first one, there’s nothing to it, and you know you are going to see at the end of this treatment,” said Dodamead, who has suffered from diabetes for 20 years.

She describes the injections:

“The nurse prepares the eye, and they do everything but take the eyeball out and scrub it on a scrub board,” she said. “They use betadine, and that cleanses it.”

After disinfecting the eye, the nurse takes a cotton swab and puts numbing medication at the point where the injection will be made, Dodamead said.

“He puts [the needle] in the eye, and it is like wham, bam, got ya. The first time it hurt; it’s like pressure. And when the eye wakes up, I thought I had the Rock of Gibraltar sitting on that eye,” she said.

For the first day after the injection, Dodamead said her vision was blurred, and her eye felt irritated, like having sand in her eye.

“After the first time, when you know what is happening, it is a piece of cake,” she said.

“And every time you go back, he takes pictures of the eye and looks at the swelling in the back of retina, and each time he says it’s getting smaller.”

Flynn said clinical trials, which are available in many major cities, “are showing tremendous success, stabilizing and often improving vision. But they are not an absolute, 100 percent cure, so blindness still occurs from the disease.”

Coupled with the epidemic of obesity in the United States, doctors expect to continue to see a high prevalence of diabetic retinopathy in the future, he said.

“I recommend that every diabetic patient have at least a yearly eye exam,” Flynn said. “Early detection, even before symptoms of visual loss occur, can often reduce or prevent progressive changes.”

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