Have Diabetes? Here’s How to Save Your Sight

Managing your diabetes can be tough, but your eyes might thank you for it.

Diabetic retinopathy is a diabetes complication that damages the retina’s blood vessels, often resulting in vision loss and blindness. The condition occurs in more than half of people with diabetes.

It affects nearly 8 million Americans and that number is expected to double by 2050, according to an American Society of Retina Specialists (ASRS) news release to mark Diabetic Eye Disease Awareness Month in November.

“With new technologies that aid in early diagnosis and breakthroughs in treatment, we’ve entered a new era in which no one with diabetes need suffer the devastating effects of diabetic retinopathy,” ASRS president Dr. Philip Ferrone said in a society news release.

“With more awareness about the condition, including the common risk factors and symptoms to watch for, everyone with diabetes can be armed with the information they need to preserve their sight,” Ferrone added.

Anyone with diabetes — including type 1, type 2 and gestational diabetes — is at risk of developing diabetic retinopathy. The longer a person has diabetes, the greater their risk. Other factors that increase the risk include: poor control of blood sugar levels over time; high blood pressure; kidney disease; high cholesterol levels; and pregnancy.

Many people have diabetic retinopathy for a long time without symptoms. By the time symptoms appear, there may be significant damage.

Symptoms may include: blurred or distorted vision; difficulty reading; spots or “floaters” in your vision; a shadow across the field of vision; eye pressure; difficulty with color perception. People with any of these symptoms should get checked as soon as possible.

Treatments for diabetic retinopathy include intravitreal (inside the eye) injections, laser treatments and surgery.

People at risk for diabetic retinopathy can protect their vision by: controlling blood sugar, blood pressure and cholesterol; maintaining a healthy weight; taking all prescribed diabetes medications; getting regular dilated retina exams; quitting smoking; and staying active.

“From focusing on healthy lifestyle habits to making regular dilated retina exams a priority, there are many ways people with diabetes can maintain excellent vision for life,” Ferrone said.

Source: HealthDay

Your Eyes May Signal Your Risk for Stroke, Dementia

Amy Norton wrote . . . . . . . . .

Your eyes may be a window into the health of your brain, a new study indicates.

Researchers found that older adults with the eye disease retinopathy were at increased risk of having a stroke, as well as possible symptoms of dementia. And on average, they died sooner than people their age without the eye condition.

Retinopathy refers to a disease the retina, the light-sensing tissue at the back of the eye. It’s often caused by diabetes or high blood pressure, both of which can damage the small blood vessels supplying the retina.

Retinopathy can lead to vision changes, such as trouble reading or seeing faraway objects. In the later stages, the damaged blood vessels may leak and cause visual disturbances like dark spots or cobweb-like streaks, according to the U.S. National Eye Institute (NEI).

Studies have linked more severe retinopathy to a higher stroke risk — possibly because both involve diseased blood vessels.

In the new study, researchers found that people with signs of retinopathy were twice as likely to report a history of stroke, versus those with no evidence of the eye disease. Similarly, they were 70% more likely to report memory problems — a potential indicator of dementia.

Over the next decade, people with the most severe retinopathy faced a two to three times higher risk of dying.

It’s not clear whether retinopathy actually foretells a future stroke or memory issues, said lead researcher Dr. Michelle Lin, an assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla.

Study participants were asked about stroke history and memory problems at the same time they were evaluated for retinopathy. It’s not clear which conditions came first, Lin said.

The next step, she added, is to follow patients with retinopathy over time, to see whether the condition predicts higher stroke risk — and whether detecting retinopathy makes a difference in that risk.

Lin will present the findings at the American Stroke Association’s annual meeting, being held virtually March 17-19. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

The results are based on more than 5,500 U.S. adults who took part in an ongoing government health study. All underwent retinal scans to look for retinopathy.

Nearly 700 were found to have the eye condition, while 289 had a history of stroke, and about 600 reported memory problems.

On average, people with retinopathy had heightened risks of stroke and memory issues — even after age, diabetes and high blood pressure were taken into account.

“It seems like there’s something about retinopathy itself,” Lin said. That is, the eye disease may give insight into what’s happening in the blood vessels of the brain.

“It’s really true that the eye is the window to the brain,” she said.

Lin encouraged people with retinopathy to work with their doctor to get control of their risk factors for cardiovascular disease, which includes stroke and heart disease. That means reining in conditions like high blood pressure, diabetes and high cholesterol.

Those measures are also key in limiting vision loss from retinopathy. Beyond that, injectable medications and laser surgery are options for more severe cases, according to the NEI.

The findings support adding retinopathy to the list of factors doctors consider in gauging patients’ stroke risk, according to Daniel Lackland, a volunteer expert with the stroke association.

That’s, in part, because detecting retinopathy is fairly simple, said Lackland, who is also a professor of epidemiology at the Medical University of South Carolina.

“And then we can work on strategies for preventing a stroke, if a person seems to have a high risk,” Lackland noted.

If people are already being treated for conditions like high blood pressure, would a retinopathy diagnosis change anything? Maybe not, though Lin said patients could be screened for memory impairment, or possibly referred for a brain MRI to look for tissue damage or problems with the blood vessels.

On the flip side, Lin said, people with cardiovascular risk factors should see an ophthalmologist to check their eye health.

Source: HealthDay

Stroke Affecting the Eye Requires Immediate Treatment, Can Signal Future Vascular Events

While most people think of strokes affecting the brain, they can also affect the eye. Central retinal artery occlusion (CRAO) is a rare form of acute ischemic stroke that occurs when blood flow is blocked to the main artery of the eye. It typically causes painless, immediate vision loss in the impacted eye, with fewer than 20% of people regaining functional vision in that eye.

Today, the American Heart Association published a new scientific statement, “Management of Central Retinal Artery Occlusion,” in Stroke, an American Heart Association journal. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Cerebrovascular Section affirms the educational benefit of the scientific statement, and it has been endorsed by the North American Neuro-Ophthalmology Society, the American Academy of Ophthalmology Quality of Care Secretariat and the American Academy of Optometry.

“Central retinal artery occlusion is a cardiovascular problem disguised as an eye problem. It is less common than stroke affecting the brain but is a critical sign of ill health and requires immediate medical attention,” said Chair of the statement writing committee Brian C. Mac Grory, M.B.B.Ch., B.A.O., M.R.C.P., an assistant professor of neurology and staff neurologist at the Duke Comprehensive Stroke Center at Duke University School of Medicine in Durham, North Carolina. “Unfortunately, a CRAO is a warning sign of other vascular issues, so ongoing follow-up is critical to prevent a future stroke or heart attack.”

In a comprehensive review of the world literature, committee members from the specialties of neurology, ophthalmology, cardiology, interventional neuroradiology, neurosurgery and vitreoretinal surgery summarized the state of the science in this condition. They found indications that this type of stroke can be caused by problems with carotid arteries, the blood vessels in the neck. However, there is also evidence CRAOs could be caused by problems with the heart, such as atrial fibrillation, which is the most common irregular heart rhythm. The risk of having a CRAO increases with age and in the presence of cardiovascular risk factors such as hypertension, hyperlipidemia, Type 2 diabetes, smoking and obesity.

The new scientific statement notes the lack of large clinical trials on CRAOs leads to uncertainty within the medical community of exactly what causes them or the best way to treat them. As a result, there is wide variability in diagnosis and treatment methods. Most concerning, according to Mac Grory, is that many practitioners may not recognize CRAO as a form of stroke resulting in patients receiving delayed testing and treatment, often in the outpatient clinic instead of the emergency department.

“We know acute CRAO is a medical emergency requiring early recognition and triage to emergency medical treatment,” Mac Grory said. “There is a narrow time window for effective treatment of CRAO and a high rate of serious related illness. So, if a person is diagnosed in a doctor’s office or other outpatient clinic, they should be immediately sent to a hospital emergency department for further evaluation and treatment.”

Current literature suggests that treatment with intravenous tissue plasminogen activator (tPA), a “clot buster” that is also used to treat brain strokes, may be effective. But tPA must be administered within 4.5 hours of the first sign of symptoms to be most effective and safe.

The writing committee also noted that emerging treatments, such as hyperbaric oxygen and intra-arterial alteplase, show promise but require further study. Other potential treatments that require further research and evaluation include novel thrombolytics to break up clots and novel neuroprotectants (substances capable of preserving brain function and structure) for use in tandem with other therapies to restore blood flow in the blocked artery.

Because of the potential for future strokes or even heart attacks, patients should undergo urgent screening and treatment of vascular risk factors. The writing committee notes that the complexities of diagnosing and treating CRAOs require a team of specialists working together. Secondary prevention (including monitoring for complications) must be a collaborative effort between neurologists, ophthalmologists, cardiologists and primary care clinicians. Risk factor modification includes lifestyle and pharmacological interventions.

Source: American Heart Association

Air Pollution Linked to Higher Risk of Sight Loss from AMD

They found that people in the most polluted areas were at least 8% more likely to report having AMD, according to the findings published in the British Journal of Ophthalmology.

Lead author Professor Paul Foster (UCL Institute of Ophthalmology) said: “Here we have identified yet another health risk posed by air pollution, strengthening the evidence that improving the air we breathe should be a key public health priority. Our findings suggest that living in an area with polluted air, particularly fine particulate matter or combustion-related particles that come from road traffic, could contribute to eye disease.

“Even relatively low exposure to air pollution appears to impact the risk of AMD, suggesting that air pollution is an important modifiable risk factor affecting risk of eye disease for a very large number of people.”

AMD is the leading cause of irreversible blindness among people over 50 in high-income countries, with the numbers of those affected projected to reach 300 million by 2040. Known risk factors include older age, smoking, and genetic make-up.

Air pollution has been implicated in brain conditions such as Alzheimer’s disease, Parkinson’s disease and stroke, while a 2019 study by the same research team found that air pollution was linked to elevated glaucoma risk.* Particulate matter exposure is one of the strongest predictors of mortality among air pollutants.

To see if air pollution might also be implicated in AMD risk, the researchers drew on data from 115,954 UK Biobank study participants aged 40-69 with no eye problems at the start of this study in 2006.

Participants were asked to report any formal diagnosis of AMD by a doctor. And structural changes in the thickness and/or numbers of light receptors in the retina – indicative of AMD – were assessed in 52,602 of the participants, for whom complete data were available in 2009 and 2012, using retinal imaging (non-invasive optical coherence tomography or OCT).

Measures of ambient air pollution included those for particulate matter (PM2.5), nitrogen dioxide (NO2), and nitrogen oxides (NOx). The estimates for these were provided by the Small Area Health Statistics Unit as part of the BioSHaRE-EU Environmental Determinants of Health Project. Official information on traffic, land use, and topography was used to calculate the annual average air pollution levels at participants’ home addresses.

The research team found that people in areas with higher levels of fine particulate matter pollution were more likely to report having AMD (specifically, they found an 8% difference in AMD risk between people living in the 25th and 75th percentiles of pollution levels), after accounting for potentially influential factors such as underlying health conditions and lifestyle. All pollutants, except coarse particulate matter, were associated with changes in retinal structure.

The researchers caution that this observational study cannot confirm cause, but their findings align with evidence from elsewhere in the world.

While they cannot yet confirm a mechanism, they suggest that ambient air pollution could plausibly be associated with AMD through oxidative stress or inflammation.

Dr Sharon Chua (UCL Institute of Ophthalmology), the paper’s first author, adds: “Higher exposure to air pollution was also associated with structural features of AMD. This may indicate that higher levels of air pollution may cause the cells to be more vulnerable to adverse changes and increase the risk of AMD.”

Source: University College London

AI-supported Test Predicts Eye Disease Three Years Before Symptoms

A pioneering new eye test, developed by scientists at UCL in collaboration with the Western Eye Hospital, London, may predict wet AMD, a leading cause of severe sight loss, three years before symptoms develop.

Researchers hope their test could be used to identify the disease early enough so that treatment can effectively prevent any vision loss.

The findings of the study, funded by Wellcome, are published in Expert Review of Molecular Diagnostics.

Wet age-related macular degeneration (AMD), also known as macular disease, is the most common cause of permanent and severe sight loss in the UK.

Currently the diagnosis of wet AMD relies on a person developing symptoms, which then leads them to seek advice from a clinician. Initially, someone with wet AMD would notice distortion in their vision, normally interfering with their reading. Very quickly, this can progress to complete central vision loss, which may be extremely troubling to elderly patients who will fear blindness and loss of independence.

Wet AMD involves abnormal growth of blood vessels, which leak fluid into the retina. The introduction of new treatments has led to much improved results for patients, for a disease that over 20 years ago was regarded as untreatable. However, patient outcomes could be even better if treatment was started in the very earliest stages of the disease.

The test, called DARC (Detection of Apoptosing Retinal Cells), involves injecting into the bloodstream (via the arm) a fluorescent dye that attaches to retinal cells, and illuminates those that are undergoing stress or in the process of apoptosis, a form of programmed cell death. The damaged cells appear bright white when viewed in eye examinations – the more damaged cells detected, the higher the DARC count.

One challenge with evaluating eye diseases is that specialists often disagree when viewing the same scans, so the researchers have incorporated an AI algorithm into their method.

Using the same technology (test) the researchers had previously found that they can detect the earliest signs of glaucoma progression.* This new study, which forms part of the same ongoing clinical trial of DARC, assessed 19 of the study participants who had already shown signs of AMD, but not necessarily in both eyes. The AI was newly trained to detect the formation of leaking and new blood vessels, which corresponded with the spots that DARC picked up.

The new analysis found that DARC can uniquely highlight endothelial cells (which line our blood vessels) under stress in the retina. These stressed cells then predict future wet AMD activity with the formation of leaking and new blood vessels seen in patients three years later, using conventional eye scans with Optical Coherence Tomography (OCT).

The researchers say their test could be valuable in detecting new lesions in someone affected by AMD, often in the opposite, unaffected eye, and may eventually be useful for screening people over a certain age or with known risk factors.

Lead researcher Professor Francesca Cordeiro (UCL Institute of Ophthalmology, Imperial College London, and Western Eye Hospital Imperial College Healthcare NHS Trust) said: “Our results are very promising as they show DARC could be used as a biomarker for wet AMD when combined with the AI-aided algorithm.

“Our new test was able to predict new wet AMD lesions up to 36 months in advance of them occurring and that is huge – it means that DARC activity can guide a clinician into treating more intensively those patients who are at high risk of new lesions of wet AMD and also be used as a screening tool.”

The study team hope to continue their research with a clinical trial with more participants, and hope to investigate the test in other eye diseases as well.

Chief Executive of eye research charity Fight for Sight, Sherine Krause said: “Our Time to Focus report on the social and economic impact of sight loss stressed the importance of early detection for prevention of sight loss, and so this is a very encouraging development in tackling the leading cause of blindness.”

Source: University College London