How Does Diabetes Affect the Eyes David Boyer MD

Approximately 20 millionthe U.S. havediabetes and one third of those are unaware they have the disease. We went to Good SamaritanLos Angeles and spoke with David Boyer, we ask him how diabetes affectsthe eyes. Well for the most part diabetes is one ofthe leading causes of blindness. It affects the eyesmany ways. One of the most commonway is with causing changesthe retina. There are two forms of changes. One is callednonproliferative diabetic retinopathy and the other is called proliferative diabeticretinopathy. Non proliferative diabetic retinopathy means that the blood vessels that we're bornwith, that nourish the retina, begin to leak

fluid, they begin to leak serum and bloodproducts and this causes swelling of the retina. The swelling of the retina actually can diminishthe vision. Proliferative retinopathy implies that you are developing abnormal blood vesselsand this is usuallyresponse to a poor blood supply that diabetes causes. The mostof the visual loss is secondary to what we call diabetic macular edema which is a leakageof serum, blood products, lipids into the center foveal area that has to do with yourability to read, watch television and to see peoples faces clearly. Diabetes forms scartissue and these abnormal blood vessels that are forming are very fragile and they canpull and they can actually pull the retina

off andthat case you have to do a surgeryto relieve all the traction to try to take the blood vessels off the surface of the retinaand to cauterize it and reattach the retina so the patient can see. Nonproliferative retinopathyfor the most part is a non surgical disease except for laser and injections. How importantis getting your diabetes under control? If you don't get your diabetes under controlthe systemic factors, the blood sugar, the blood pressure and the lipids, you're goingto have continued damage not only to your eyes but to the rest of your body, to yourkidneys, and to the nerves that supply the sensory input to your legs so you'll end upwith neuropathy, kidney problems and other

changes that can occur. It's been shown innumerous studies that if you can get your blood sugar under excellent control for longperiods of time up to 26 months, then you can actually get a reversal of a lot of thediabetic changes. So it's not inevitable that it will continue to worsen. Blood pressureis also very important and control of your lipids and so it is extremely important thatyou continue with your internist or your diabetologist or endocrinologist who's going to be takingcare of your diabetes to get your A1C Hemoglobin or a measure of average blood sugar over a3 month period into as low a range as you can safely and by doing this over a long periodof time you can actually improve your retinopathy.

Boyer tells us about the new advancesfor diabetes. Well actuallythe last several months there's been a major breakthrough inour treatment of diabetic retinopathy. al trials and a stage 3 were able to show a markedimprovementthe visionpatients that received ranibizumab treatment or Lucentisis the trade name, every month for over a 3 year period and they were actually get animprovement to 36 to 40 percent of the patients actually getting 3 lines of improvement whichis much much higher than we every have with laser, which wasthe range of 3 to 15 percent,3 line gainers. So this is really a new paradigm for ophthalmologists and for patients. Weare able to treat patients without causing

any damage to the central area, cause laseris destructive even though it does work it is somewhat destructive. So we are limitedhow close we can get to the center when we treat with this we're able to treat and ifwe can treat aggressivelly, we'll be able to save a lot more patients from going blind.