Diabetic patients tell how local MDs protect their vision with laser & injection treatments
With the burgeoning diabetes epidemic in our nation, chances are you know at least one of the more than 329,000 Wisconsinites living with the disease. Perhaps you are one of them. Or, you may become one. If so, take note. Diabetes does more than wreak havoc with blood sugar levels. Without taking proper precautions, it can rob a person of their sight. And, if you are Black, you have a three times greater risk of losing vision to diabetes than a White person.
Retired Milwaukee police officer Eugene Fischer, 69, was diagnosed with pre-diabetes in 1972, became insulin-dependent by 1980, and was diagnosed with diabetic retinopathy in 1991. Reflecting on his 38-year battle with the disease and its effects on his eyes, Fischer says, “I haven’t had any physical pain, but I have had a lot of distress. There have been several times where I thought I’d lose my sight—where I was almost legally blind because of leaking blood vessels. When a vessel would break in my eye, I would see sheets of blood. It was frightening! . . . It’s enough to give a diabetic incentive to monitor their blood sugar levels and follow their doctor’s orders. Had I not been recommended to Dr. Freedman by a friend, I believe I’d be blind today. I thank the Lord for sending me to him.”
How does diabetes affect vision?
Dr. Mark Freedman, a leading area eye surgeon and lecturer on diabetic eye disease, explains, “Mr. Fischer developed what is called ‘diabetic retinopathy.’ What happens is that, with diabetes, high blood sugar levels can weaken blood vessels in the eye, causing them to leak blood or fluid. This causes the retina to swell and form deposits that can lead to vision loss. Blood sugar fluctuations can also promote the growth of new, fragile blood vessels on the retina, which can sometimes leak blood into the vitreous (the clear, jelly-like substance that fills the eyeball). This retinal blood vessel damage, or retinopathy, can blur vision and lead to permanent visual impairment.”
Who is most at risk for retinopathy?
Fischer is not alone. “Of the 20+ million Americans diagnosed with diabetes, up to 45 percent have some degree of diabetic retinopathy (damage to the retina). Nearly a million have it severe enough to cause vision loss and up to 25,000 go blind each year,” reports Dr. Norman Cohen, co-founder of Eye Care Specialists, an ophthalmology practice that has treated tens of thousands of diabetic patients since 1985. He adds, “Because African-Americans have a higher incidence of diabetes, they are also at higher risk of blindness from diabetic eye disease. The impact of this could take on devastating economic proportions as this segment of the population grows and as more Blacks reach the age of highest risk.”
“Diabetic eye disease can appear as early as a year after the onset of diabetes. And, all diabetics—Type 1, Type 2, insulin-dependent or not—are at risk. And, the risk increases with the number of years you have diabetes. For example, patients with diabetes for less than five years have about a 15 percent incidence of retinopathy. This risk skyrockets, however, to 80 percent in people who are diabetic for 15 or more years,” explains Dr. Robert Sucher, eye surgeon and fellow co-founder of Eye Care Specialists.
What are the symptoms of diabetic eye disease?
Louis Sticks, 66, of Watertown , was diagnosed with Type II diabetes at age 46. Like Fischer, his diabetes didn’t initially affect his eyes. “It crept up on me really,” explains Sticks, owner of Brook Falls Organ & Piano Co. in Butler . “I’d be reading music, and notes would just seem to disappear and reappear. I would tell people I was having a ‘bad eye day.’ But, it began to happen a lot, and it became worrisome.” Sticks went back to his general doctor who examined his eyes and told him to see an ophthalmologist. Like Fischer, he sought out the expertise of the doctors at Eye Care Specialists. How is retinopathy detected?
“Unfortunately, a ‘bad eye day’ is a lot more serious than a ‘bad hair day.’ It may be that a patient’s blood sugar levels are off that day, which can temporarily affect vision. Or, it could be a sign that a much greater problem is developing. That’s why it’s crucial for diabetics to schedule yearly dilated eye exams,” advises Dr. Daniel Ferguson, an eye care specialist who sees patients from all walks of life at three offices in the Milwaukee area. “Usually there are no symptoms. However, significant retinopathy may be present and progressing even if a person’s vision still appears to be good. In fact, many people don’t notice a problem until the retinopathy is so far advanced that lost vision can’t be restored.” Ferguson explains, “Diabetic eye disease can only be diagnosed through a comprehensive eye examination. Pupil dilation (enlargement with drops) is necessary to best check the back of the eye for early signs of retinopathy before noticeable vision loss occurs.” He adds, “What’s most frustrating to us is that diabetes-related sight loss is often preventable with yearly exams and early intervention. But all of our expertise, lasers and treatments are of no use if patients don’t come in and have their eyes regularly checked.”
What are the treatment options?
Fischer and Sticks, however, have been proactive in protecting their vision. Both have had laser therapy. Fischer recently underwent cataract surgery to remove the cloudy natural lens inside the eye and replace it with a prescription implant. And, Sticks has had success with new medication injection treatments to treat his diabetes-related eye damage.
“Although not all diabetics can have or need it, laser treatment is extremely effective in reducing the incidence of severe vision loss—in some cases by at least 50 percent— especially if started early enough,” states Brett Rhode, Head of Ophthalmology at Aurora Sinai Medical Center and a partner at Eye Care Specialists private practice. “In cases where laser therapy is not possible or effective, we have been very pleased with the success of new medications that can be painlessly injected directly into the eye to decrease leakage from blood vessels and decrease the growth of new abnormal vessels— thus staving off progression of the disease.” Freedman adds, “We’ve seen some amazing results with Avastin and Triesence, including not only stabilization of vision, but in some cases, improvement in sight. However, we must evaluate each patient’s response individually to determine if and when (often every 6-12 weeks) they should receive injections.”
“We have also been thrilled to be able to utilize these injectable medications for treating another condition that affects the blood vessels of the macula—age-related macular degeneration (AMD). This is extremely rewarding because, until recently, there wasn’t much hope for helping these patients retain their central vision,” states Ferguson.
Advice from patients
By keeping his diabetes under control, Sticks is able to continue singing in his church choir and filling in as organist. He notes, “I would tell anyone who is diagnosed with diabetes to go and see their eye doctor right away. I have told other people what I have gone through and, if they don’t have a doctor, I send them to Eye Care Specialists.”
Fischer credits both vigilance with his eye appointments and physical activity for his continued good vision. “There’s no better exercise than a walk,” says Fischer, who enjoys taking strolls with his wife, especially when they visit the Disney parks in Florida . “I also keep myself busy working hard at my daughter’s stable in Oak Creek .” Fischer is quick to point out that, since working with the horses, he hasn’t needed any additional laser treatments and, “It’s amazing, my eyeglasses prescription hasn’t changed in five or six years.”
Fischer offers the following advice, “If I had any message for diabetics out there, it would be to monitor your blood sugar levels and get a good eye doctor—between those two things, you have a good chance of keeping your sight. If you only have one or the other, you only have half of the equation.”
The physicians quoted in this article are partners at Eye Care Specialists, SC. Since 1985, this leading ophthalmology practice has provided comprehensive medical, surgical and laser care for virtually every eye condition to more than 121,000 southern Wisconsinites at locations in West Allis, Wauwatosa and downtown Milwaukee. To schedule a comprehensive eye exam or to receive free educational booklets on diabetes, cataracts, glaucoma, dry eyes or macular degeneration, call their Community Education Hotline at 414-321-7035, or visit their website at eyecarespecialists.net.