Comments on: Diabetes Unlikely to Cause Blindness http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/ Randall V. Wong, M.D., Retinal Specialist Thu, 02 Feb 2012 21:41:09 +0000 hourly 1 http://wordpress.org/?v=3.1.4 By: Joshua http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2906 Joshua Sat, 26 Nov 2011 21:35:49 +0000 http://retinaeyedoctor.com/?p=487#comment-2906 By the way, what is the definition of Severe vision loss? Vision better than 20/200? Obviously no Diabetic wants to lose even "Moderate" vision. Mild one can deal with, but I am always curious about the subjectivity of what avoiding Severe vision loss means. ;-) If one has 20/20 vision, does this mean despite any controls, they will not maintain that if they do all the precautions? Sorry for all the questions, I just never had anyone to ask before. By the way, what is the definition of Severe vision loss? Vision better than 20/200? Obviously no Diabetic wants to lose even “Moderate” vision. Mild one can deal with, but I am always curious about the subjectivity of what avoiding Severe vision loss means. ;-) If one has 20/20 vision, does this mean despite any controls, they will not maintain that if they do all the precautions? Sorry for all the questions, I just never had anyone to ask before.

]]> By: Joshua http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2905 Joshua Sat, 26 Nov 2011 19:57:04 +0000 http://retinaeyedoctor.com/?p=487#comment-2905 By the way, you mean Deborah Kletzky Schlossman? I know a few people who go to her. I hear a very nice Dr with a good bedside manner. By the way, you mean Deborah Kletzky Schlossman? I know a few people who go to her. I hear a very nice Dr with a good bedside manner.

]]> By: Joshua http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2903 Joshua Sat, 26 Nov 2011 19:36:16 +0000 http://retinaeyedoctor.com/?p=487#comment-2903 I meant DME not DEM. ;-) Sorry too many typos from typing quickly. I meant DME not DEM. ;-) Sorry too many typos from typing quickly.

]]> By: Joshua http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2902 Joshua Sat, 26 Nov 2011 19:31:42 +0000 http://retinaeyedoctor.com/?p=487#comment-2902 Thanks for the response. I go to Joslin every 6 months. I am a patient of the Sr Beetham ophthalmologist there who is also a specialist in trial studies . Who is a very excellent dr. I have been going to him since I was a kid in fact. So almost 22 years. I just think I am a very nervous person who likes to have as much information as possible. Some Dr's are not all as forthcoming as you, but at the same time, I think he is so conservative, that unless he seems concerned about my condition, I try to keep it in perspective. Both he and My endo ( who is also really one of the tops Joslin Drs there, whos specilaty is Complications in T1s) think I will not go to PDR simply because I am so hyper aware of anything in my vision and that it has not progressed. I have a BP of 116/75 on average, low body fat, take lisinoprel and lipator for prevention, no other complications and low body fat, and work out 3-4 xs a week. I usually get most bothered by CWS every once in a while, but they are usually a result of a very wide fluctuation in my BG. (Actually it is not the CWS, but the infarct at the root of them that cases visual disturbance. ) I had not had an A1c below a 7.5-8.0 in a number of years, and both feel once I get into the low 7 high 6 range and keep it stable that then on. This I think is key, as the consistency seems more important than an A1c. My goal is to create a long term memory for the Retinopathy in the next 3-4 years ;-) and hopefully that will result in less changes. I find A1cs to be misleading about actual control. You can have wide swings in BG together and somehow get a low A1c. Even in the DCCT, the tight control group was only in that range, and the conventional was in the 9s.... much higher than current guidelines. Long story short, It is more years of me even after being told I would fine if I followed the path, and then freaking out because I would have changes in my vision due to the CWS every so often, which would make me spiral into obsessive research behaviors and only finding grim stats. . Low blood sugars seems to have a worse effect due to the lack of nutrients and glucose the the eyes... so I have been trying to lower the BGs more gradual without Hypos.. But to be honest, I would think it would be more a case of lowering from a long term 10 down tot a 6 quickly that would cause this temporary decline. I am interested in why the retinal blood flow increases in those patients with transient worsening. There is so much contradictory info out there. At the end of the day, All I need from an emotion standpoint is someone to tell me, what I am doing can prevent Moderate NPDR ( only micos and occasional CWS with stable Non Clin focal DEM which has reabsorbed in the past) to either make it stable or even potentially reverse a little to Mild , if I could normalize glucose levels long term. I have kept it at Moderate NPDR for 6 years, and to be honest with myself I could do even more by lowering the A1c <7. Because of this I have been told the likelihood of progression is small. But there is always a voice in the back of your head saying you could still be a statistic. I think many eye Dr's forget how much guilt Diabetics have when they arrive at complications of any kind. But Retinaopathy is by far the most emotionally devastating for the majority. Sorry for the rant. ;-) I had a lot on my chest. Lol Thanks again for humoring , Josh Thanks for the response.
I go to Joslin every 6 months. I am a patient of the Sr Beetham ophthalmologist there who is also a specialist in trial studies . Who is a very excellent dr. I have been going to him since I was a kid in fact. So almost 22 years. I just think I am a very nervous person who likes to have as much information as possible. Some Dr’s are not all as forthcoming as you, but at the same time, I think he is so conservative, that unless he seems concerned about my condition, I try to keep it in perspective. Both he and My endo ( who is also really one of the tops Joslin Drs there, whos specilaty is Complications in T1s) think I will not go to PDR simply because I am so hyper aware of anything in my vision and that it has not progressed. I have a BP of 116/75 on average, low body fat, take lisinoprel and lipator for prevention, no other complications and low body fat, and work out 3-4 xs a week. I usually get most bothered by CWS every once in a while, but they are usually a result of a very wide fluctuation in my BG. (Actually it is not the CWS, but the infarct at the root of them that cases visual disturbance. ) I had not had an A1c below a 7.5-8.0 in a number of years, and both feel once I get into the low 7 high 6 range and keep it stable that then on. This I think is key, as the consistency seems more important than an A1c. My goal is to create a long term memory for the Retinopathy in the next 3-4 years ;-) and hopefully that will result in less changes. I find A1cs to be misleading about actual control. You can have wide swings in BG together and somehow get a low A1c. Even in the DCCT, the tight control group was only in that range, and the conventional was in the 9s…. much higher than current guidelines.

Long story short, It is more years of me even after being told I would fine if I followed the path, and then freaking out because I would have changes in my vision due to the CWS every so often, which would make me spiral into obsessive research behaviors and only finding grim stats. . Low blood sugars seems to have a worse effect due to the lack of nutrients and glucose the the eyes… so I have been trying to lower the BGs more gradual without Hypos.. But to be honest, I would think it would be more a case of lowering from a long term 10 down tot a 6 quickly that would cause this temporary decline. I am interested in why the retinal blood flow increases in those patients with transient worsening. There is so much contradictory info out there.
At the end of the day, All I need from an emotion standpoint is someone to tell me, what I am doing can prevent Moderate NPDR ( only micos and occasional CWS with stable Non Clin focal DEM which has reabsorbed in the past) to either make it stable or even potentially reverse a little to Mild , if I could normalize glucose levels long term. I have kept it at Moderate NPDR for 6 years, and to be honest with myself I could do even more by lowering the A1c <7. Because of this I have been told the likelihood of progression is small. But there is always a voice in the back of your head saying you could still be a statistic. I think many eye Dr's forget how much guilt Diabetics have when they arrive at complications of any kind. But Retinaopathy is by far the most emotionally devastating for the majority.

Sorry for the rant. ;-) I had a lot on my chest. Lol
Thanks again for humoring ,
Josh

]]> By: Randall V. Wong, M.D. http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2897 Randall V. Wong, M.D. Sat, 26 Nov 2011 12:40:16 +0000 http://retinaeyedoctor.com/?p=487#comment-2897 Dear Joshua, Hang in there. If you are this motivated to find out so much information about your disease, you should find a doctor who can relate to you, too. I trained with the famous Dr. Kletzky. Can you go back to Joslin? r Dear Joshua,

Hang in there. If you are this motivated to find out so much information about your disease, you should find a doctor who can relate to you, too.

I trained with the famous Dr. Kletzky. Can you go back to Joslin?

r

]]> By: Joshua http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-2881 Joshua Sat, 26 Nov 2011 03:16:56 +0000 http://retinaeyedoctor.com/?p=487#comment-2881 Dr Wong, I have been a T1 Diabetic since 1980. Been a patient of Joslin since then and go to regualr eye appointments every 6 months at Beetham. I am 37 now and had T1 for 32 years. I have been an average diabetic for most of my life, periods of rebellion in my teenage years. I was Diagnosed with MILD NPDR in 2000, ( which as we all know is not atypical). Since then, I have progressed to Moderate NPDR ( 6 years ago) and have had non clinically significant DME for many more. Focal leakage only. I have over the years WRACKED my brain checking online about progression statistics. Over the past 10 years I have done more reseach than a typical med student to try and understand the pathologies. As we all know It all comes down to compliance with the appointments and taking control of the A1c. I am happy to say I am mostly in the 7s. But even that is too high for my liking, as I want to assure I wont progress to Severe NPDR...as I find by then the momentum to be more risky to PDR. I wanted to thank you for writing this. My opthamologist is wonderful, and a very well respected Dr in his field, but a very old school man with not the most approachable bedside manner, so you speaking in laymans terms... about what I exactly wanted to hear.. was a huge blessing. I got off the phone with my Endo today who also said almost exactly the same thing as you, so the timing of me finding this will hopefully help me sleep a little better at night. The gap in info between pure statistics and shock tactics to get people awake to the importance of going to appointments... sometimes those compliant but scared patients need to hear some reassurance, that what they are doing WILL matter in the long run, and not all of us are destined to severe vision loss. The DCCT results can only do so much to calm us. THANK YOU. Dr Wong,
I have been a T1 Diabetic since 1980. Been a patient of Joslin since then and go to regualr eye appointments every 6 months at Beetham. I am 37 now and had T1 for 32 years. I have been an average diabetic for most of my life, periods of rebellion in my teenage years. I was Diagnosed with MILD NPDR in 2000, ( which as we all know is not atypical). Since then, I have progressed to Moderate NPDR ( 6 years ago) and have had non clinically significant DME for many more. Focal leakage only. I have over the years WRACKED my brain checking online about progression statistics. Over the past 10 years I have done more reseach than a typical med student to try and understand the pathologies. As we all know It all comes down to compliance with the appointments and taking control of the A1c. I am happy to say I am mostly in the 7s. But even that is too high for my liking, as I want to assure I wont progress to Severe NPDR…as I find by then the momentum to be more risky to PDR.

I wanted to thank you for writing this. My opthamologist is wonderful, and a very well respected Dr in his field, but a very old school man with not the most approachable bedside manner, so you speaking in laymans terms… about what I exactly wanted to hear.. was a huge blessing. I got off the phone with my Endo today who also said almost exactly the same thing as you, so the timing of me finding this will hopefully help me sleep a little better at night. The gap in info between pure statistics and shock tactics to get people awake to the importance of going to appointments… sometimes those compliant but scared patients need to hear some reassurance, that what they are doing WILL matter in the long run, and not all of us are destined to severe vision loss. The DCCT results can only do so much to calm us. THANK YOU.

]]> By: Murray Newcomb http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-245 Murray Newcomb Fri, 23 Oct 2009 17:45:28 +0000 http://retinaeyedoctor.com/?p=487#comment-245 Hi Randy I am reading your site. Will see you thursday at 9:00 AM My co-workers gave me a eye patch today. Should I wear it or not. Thank Murray Newcomb 703-501-8395 Hi Randy
I am reading your site.
Will see you thursday at 9:00 AM
My co-workers gave me a eye patch today. Should I wear it or not.

Thank
Murray Newcomb
703-501-8395

]]> By: Randall V. Wong, M.D. http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-233 Randall V. Wong, M.D. Thu, 15 Oct 2009 22:43:28 +0000 http://retinaeyedoctor.com/?p=487#comment-233 Thanks for your support. With your help, I hope that this site becomes a useful and credible resource for my patients and their "non-retina" doctors. Stay tuned! Randy Thanks for your support. With your help, I hope that this site becomes a useful and credible resource for my patients and their “non-retina” doctors.

Stay tuned!

Randy

]]> By: Joanne http://www.retinaeyedoctor.com/2009/10/diabetes-unlikely-to-cause-blindness/comment-page-1/#comment-231 Joanne Thu, 15 Oct 2009 21:06:48 +0000 http://retinaeyedoctor.com/?p=487#comment-231 I like the informative and intersting article format of your blog, Dr. Wong, You write it as if you are talking to a patient in the office; clear and direct, using good examples. You need to get the word out there that this helpful info is here for patients! The Glossary is also very helpful. Thanks. I like the informative and intersting article format of your blog, Dr. Wong, You write it as if you are talking to a patient in the office; clear and direct, using good examples. You need to get the word out there that this helpful info is here for patients! The Glossary is also very helpful. Thanks.

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