IF YOU CAN STAY IN GOOD BLOOD
GLUCOSE CONTROL, IT’S BETTER
THAN ANY DRUGS WE CAN GIVE.
;EMILY CHEW, MD
People with diabetes hold the
greatest power in keeping their
eyes healthy. “If you can stay in
good blood glucose control, it’s
better than any drugs we can give,”
Chew says. In recent years, clinical
trials have shed light on how to
prevent diabetic retinopathy and
The Action to Control Cardiovascular Risk
in Diabetes (ACCORD) Eye Study found that
tight glucose control in adults with type; 2—
an average A1C of 6. 4;percent—reduced the
risk of diabetic retinopathy progression
by up to 70;percent, compared with those
whose average A1C was 7. 7;percent.
Interestingly, even though the average
A1C (a measure of blood glucose over time)
of the tight-control group rose to around
7. 8;percent four years after the trial, the
group continued to have a 50;percent lower
risk of diabetic retinopathy progression.
“It’s what we call a metabolic memory, or
legacy effect, that continues,” says Chew,
the study’s lead author. “It’s really worth it
to put that money in the bank [and get your
glucose under control] when ;rst diagnosed
with diabetes.” Other studies have shown
tight control reduces the risk of retinopathy
in people with type; 1 diabetes as well.
According to a 2017 American Diabetes
Association position statement on diabetic
retinopathy, published in the March issue
of Diabetes Care, maintaining blood
pressure of 140;mmHg or lower
has been shown to decrease
retinopathy progression in
people with type; 2.
Most ophthalmologists screen for
retinopathy by taking a picture of the retina
to see if any blood spots are visible. In the
last two years, a new form of imaging,
called optical coherence tomography
angiography, or OC TA, has emerged. It’s not
yet widely available but can detect diabetic
retinopathy long before vessels start leaking
blood and ;uid.
This new technology allows your doctor
to see into the retina to examine blood
;ow, swelling, and whether your eye is
losing blood vessels, Rosen says. Your
ophthalmologist can also measure how
the disease has progressed at each visit.
“We can tell if [the person] is losing
capillaries—and how fast,” says Rosen.
You’ll receive laser treatment when
abnormal blood vessels start to grow on
the retina. The laser burns 1,000 to 2,000
tiny spots on the outer areas of the retina
in order to shrink the fragile, bleeding
blood vessels. This saves central vision
but sacri;ces peripheral, or side, vision.
An experimental treatment may provide
an alternative. Instead of burning
areas of the retina to get rid
of leaky blood vessels,