Diabetic Retinopathy

The eye drug Lucentis has been approved by the Food and Drug Administration for treating the disease diabetic macular edema (DME). This drug was originally developed by Roche to treat cancer. Lucentis has also been approved to treat two eye disorders, macular degeneration and now, diabetic macular edema.

The leading cause of new cases of blindness in adults in the US is diabetes. Diabetic macular edema causes swelling and blurred vision. Without treatment, it can result in permanent vision loss. Of the 26,000 Americans with diabetes, more than 560,000 are estimated to have diabetic macular edema. All diabetics should have a comprehensive dilated annual eye examination to screen for this disease, as it may have no symptoms in the early stages.

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As people age, eye diseases and conditions that commonly occur include macular degeneration, cataracts, vitreous tears/retinal tears and detachments, glaucoma, diabetic retinopathy, dry eyes, and eye floaters.

The question arises as to whether eye disease is inevitable with age. Will all older adults eventually have a “glint” in their eyes after cataracts surgery? More than 50% of people aged 75+ have glaucoma, cataracts, or macular degeneration. Can aging adults do anything to prevent, manage or slow down eye diseases associated with aging?

A large body of research is accumulating that shows the effects of regular eye exercises, good nutrition, and targeted supplementation on preventing and/or managing eye conditions. For instance, peer-reviewed research has shown that the risk of getting macular degeneration can be significantly reduced by taking fish oil and lutein on a daily basis. Vigorous exercise may reduce the incidence of glaucoma. And the effects of antioxidants on preventing cataract and macular degeneration have been the subject of significant research.

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The obesity epidemic may have an impact on the health of the eyes. While scientific studies do not seem to have found a direct link between obesity and eye disease, maintaining a healthy weight supports your overall health and helps prevent diseases that can harm the eyes. Here’s why.

Obesity is a step up from “overweight.” The National Institute of Health (NIH) in the United States, commonly uses Body Mass Index (BMI). This is a ratio of height to weight. Overweight is a BMI of 25-29, and obesity is a BMI of 30 or more. For example, 5′ 7″ person who weighs 160 pounds would have a BMI of 25 (just barely overweight). This same person at 195 pounds would have a BMI of 30 (obese) and at serious risk of disease such as heart disease, cardio-vascular disease, stroke, cancer, diabetes and lower-body joint problems.

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Drug maker GlaxoSmithKline has been found guilty of fraud in the way it reported research on, or marketed, on 3 of its medications in the largest settlement against a drug company in US history–$3 billion. The issues involved 10 drugs, and included marketing “off-label” use of the antidepressants Paxil and Wellbitrin and the asthma drug Advair, and not reporting all the safety data for the diabetes drug Avandia.

GlaxoSmithKline pleaded guilty and agreed to pay $3b total in both criminal fines and civil settlements with the federal and state governments. The fines will be paid next year.

In a press conference, Deputy US Attorney General James Cole said the settlement was “unprecedented in both size and scope.”

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The brain and the body are in constant relationship.  This truth is further supported by the recent study published in General Hospital Psychiatry that describes how people who suffer from both depression and diabetes are more likely to end up with diabetic retinopathy.

In a study that controlled such factors as obesity, smoking, and activity, diabetic retinopathy was linked to occurrences of depression.  Over the five year trial, almost one quarter of patients with depression developed the eye disease compared to less than 20% of those who did not have depression.  Researchers extrapolate that depression increases one’s risk of developing retinopathy by 15%.
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Changes in lifestyle are usually the most important way that individuals with diabetes can control their conditions.  Most people seem to know this, but a new survey shows that many diabetics do not follow that advice.

A study called SHIELD (The Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes), which was presented at the annual meeting of the American Diabetes Association, surveyed nearly 4,000 people with type 2 diabetes.  In response to questions about the link between diabetes and obesity, 87% said they knew excessive weight contributed the disease, but only 70% of respondents reported trying to lose weight in the preceding year.  Only a third of those surveyed had managed to maintain their target weight for longer than six months.  Almost one-fifth of those studied (17%) said they preferred to take medication to control their conditions rather than try diet and exercise.
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The American Optometric Association has played an active role in the Centers for Disease Control and Prevention (CDC) Division of Diabetes Translation (DDT) for over ten years.  Eye docs hanging out with diabetes specialists?  Of course.  Diabetic retinopathy, according to the National Institute of Health, affects “4.2 million—28.5%— of people with diabetes ages 40 years or older … and of these, 655,000—4.4% of those with diabetes—had advanced diabetic retinopathy that could lead to severe vision loss.”

W. Lee Ball, O.D., AOA Associate Director for Quality Improvement gave a presentation entitled “Working Together to Manage Diabetes: Development and Testing of a Comprehensive Checklist.”  Of the medical professionals across several fields who responded to a questionnaire regarding the efficacy of the checklist, 74% said they found it useful in a real-world clinical setting.  Source: News from the AOA
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Researchers, specifically a group at Harvard’s Joslin Diabetes Center, are understanding the connection between diabetic retinopathy and proteins present in the eyes.  In a 2007 study, scientists describe how they found a group of proteins that they believe are responsible for causing the leakage from blood vessels that marks diabetic retinopathy.  They found that these proteins were also the cause of swelling in the eyes, a discovery that could have an impact on research related to cerebral swelling caused by head injuries and strokes.  Figuring out the role of proteins in this condition opens up new treatment avenues for both eye diseases and brain injuries and conditions.
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Inflammation and Diabetic Retinopathy

At Natural Eye Care, we know that eye conditions are often related to diseases that affect the entire body.  At a conference last year, Clement Trempe, MD reminded colleagues to consider the role of overall inflammation when diagnosing patients with diabetic retinopathy.

According to Dr. Trempe, “Diabetic retinopathy is not an eye disease, but part of a chronic systemic inflammatory disease process that shares the same risk factors and elevated biomarkers associated with coronary vascular and neurodegenerative diseases such as age-related macular degeneration, glaucoma and Alzheimer’s.”
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