Telemedicine Can Expand Screening for Retinopathy

Action Points

  • A study found that retinal photography with telemedicine communication to an offsite specialist was successful in a primary care practice for screening diabetics for diabetic retinopathy.
  • Note that the majority of patients screened did not have retinopathy but that rates and severity of disease were higher among Continue reading

Antioxidant Shown to Reduce Blindness Risk in Extremely Premature Babies

Retinopathy of prematurity (ROP) is the second most common cause of childhood blindness in the United States, occurring in half of premature infants born earlier than or at 28 weeks gestational age. The condition is caused by abnormal blood vessel development in the retina of the eye. ROP risk increases with decreasing gestational age.

A study by researchers at Brigham and Women’s Hospital (BWH) suggests that the antioxidant, rhSOD (recombinant human Cu/Zn superoxide dismutase), reduces the risk of developing ROP in extremely low gestational age newborns. Continue reading

Telemedicine Effective in Retinopathy Screening

retinaOphthalmologists can effectively screen infants for retinopathy of prematurity by looking at their retinal images from a remote location, researchers reported here at the American Telemedicine Association 17th Annual International Meeting.

Over the course of 4.5 years, 2 pediatric ophthalmologists Continue reading

Salk Scientists Say: It’s not an Apple a Day after all – It’s Strawberries

A recent study from scientists at the Salk Institute for Biological Studies suggests that a strawberry a day (or more accurately, 37 of them) could keep not just one doctor away, but an entire fleet of them, including the neurologist, the endocrinologist, and maybe even the oncologist.

Investigations conducted in the Salk Institute’s Cellular Neurobiology Laboratory (CNL) will appear in the June 27, 2011, issue of PLoS ONE. The report explains that fisetin, a naturally-occurring flavonoid found most abundantly in strawberries and to a lesser extent in other fruits and vegetables, lessens complications of diabetes. Previously, the lab showed that fisetin promoted survival of neurons grown in culture and enhanced memory in healthy mice. That fisetin can target multiple organs strongly suggests that a single drug could be used to mitigate numerous medical complications.

“This manuscript describes for the first time a drug that prevents both kidney and brain complications Continue reading

Eye Disease Affects Nearly One in Three Diabetics

Almost one in three people with diabetes has evidence of the eye disease called diabetic retinopathy, according to new research.

 What’s more, over 4 percent of people with diabetes have diabetic retinopathy that’s so advanced it’s threatening their vision, reports the study published in the Aug. 11 issue of the Journal of the American Medical Association.

 “This was a national population-based study and we found that among Americans with diabetes who were age 40 and older, that 28.5 percent — or 4.2 million people — have diabetic retinopathy. And, 4.4 percent had vision-threatening diabetic retinopathy,” said the study’s lead author, Dr. Xinzhi Zhang, an epidemiologist with the U.S. Centers for Disease Control and Prevention in Atlanta.

 The news wasn’t all bad, however. The findings suggest that good control of blood sugar, blood pressure and cholesterol can go a long way toward preventing or slowing diabetic eye disease. And treatment with laser surgery may be helpful for those with more advanced retinopathy.

 “If you have diabetes, take good care of your diabetes and get your eyes examined regularly,” advised Zhang. “If you find problems early and get treatment, you can delay or prevent the loss of vision.”

 Diabetic retinopathy causes changes in the blood vessels in the eyes. In some cases, new and abnormal blood vessels grow, and in other cases, existing blood vessels swell and leak, according to the U.S. National Eye Institute. Diabetic retinopathy remains the number one cause of vision loss in people aged 20 to 74 in the United States, according to background information in the study.

 The last study that looked at national prevalence of diabetic retinopathy was done between 1988 and 1994. To get an updated estimate of what the prevalence of the eye disease might be now, Zhang and his colleagues reviewed data from the National Health and Nutrition Examination Survey from 2005 to 2008, which included nearly 7,000 people over age 40.

 Of those people, 1,006 reported that they had been diagnosed with diabetes, or they had a hemoglobin A1C reading above 6.5 percent. Hemoglobin A1C is a measure of long-term blood sugar control, and according to the American Diabetes Association, someone who has a level of 6.5 percent or higher has diabetes. The study did not differentiate between type 1 and type 2 diabetes.

 In addition to finding that nearly one in three people with diabetes has some form of diabetic retinopathy, the researchers also found that slightly more men than women have the disease (about 32 percent versus 26 percent), and blacks and Mexican Americans have a higher rate of the disorder than whites (about 39, 34 and 26 percent, respectively).

 Other risk factors for diabetic retinopathy found in the study included a higher A1C level (which indicates poor blood sugar control), higher systolic blood pressure, a longer duration of diabetes and insulin use.

 Zhang said that many of these risk factors, such as a high A1C or the need for insulin (in type 2 diabetics) might indicate more severe diabetes, which is more likely to result in diabetic retinopathy.

 “I was surprised to see that there’s still such a high prevalence of diabetic retinopathy,” said Dr. Richard Bergenstal, president of medicine and science for the American Diabetes Association. “We’ve made a lot of progress in treating diabetes and the hope is always that the complications are going away, but we still have a lot of people who aren’t quite to goal in terms of blood sugar management.”

 Bergenstal said that everyone with type 2 diabetes should have a dilated eye exam soon after they’re diagnosed with diabetes, because they’ve likely had diabetes for a while without knowing it. After the initial exam, he said, a dilated eye exam is needed every year thereafter. People just diagnosed with type 1 diabetes may be able to wait a few years before having their first dilated eye exam, but then should have one every year after as well.

 Bergenstal said that to help prevent retinopathy, people with either type of diabetes need to maintain good blood sugar levels, keep their blood pressure controlled, and lower their cholesterol with medications, if necessary.