New Treatments for Diabetic Eye Diseases

Diabetic retinopathy is an insiduous disease. In the United States, about half of people who are at risk for retinopathy don't even know that they have diabetes. A significant number of people, over 20,000 a year, only learn they have diabetes when they have already gone blind.

Of those who have been diagnosed with diabetes, about 2 percent in any given year will be diagnosed with a sight-threatening condition, such as diabetic retinopathy, diabetic maculopathy, cataracts, or glaucoma. It's essential for everyone to get regular screenings for diabetes, and it's essential for all diabetics to keep blood sugar levels in control and to get regular eye exams. There's no better prevention for diabetic eye disease than keeping sugars in acceptable ranges 24/7/365. but there are also new devices that prevent or slow down the progression of eye disease or offer easier treatment.

Procedures to Save Vision Sometimes Cause Tiny Blind Spots

The most common complication of diabetes in the eyes is a condition known as diabetic retinopathy. In the early stages of the disease, there may be no visual symptoms, but an eye exam reveals twists and turns and bulges in the blood vessels in the back of the eye known as microaneurysms. At this stage, the condition is "non-proliferative," that is, there is a problem with existing blood vessels but it is not yet compounded by growth of new blood vessels. As the condition progresses and becomes "proliferative," new tiny blood vessels pop up in the retina and cause blurred vision, empty spots in the field of vision, specks, floaters, and difficulty seeing at night. These new, fragile blood vessels may leak in the fluid in the eyeball, obscuring vision even more.

The standard treatment for advanced proliferative diabetic retinopathy is a procedure called multispot laser Panretinal photocoagulation, or PRP. The ophthalmologist uses a laser to weld tiny blood vessels shut so they do not leak. What patients eager to have the surgery to save their site sometimes fail to hear (or aren't told) by their doctors is that everywhere the doctor welds a vessel shut, a tiny blind spot is created. In some cases, there can be loss of peripheral vision so that after the procedure, driving is impossible.

Noctura for Preventing Progression of Diabetic Retinopathy

If nothing is done for too long in proliferative diabetic retinoapthy, there may be no alternative to PRP. For cases that aren't as advanced, there is a new device called Noctura 400 Sleep Mask, manufactured by PolyPhotonix Ltd. Consisting of a sleep mask with a light-emitting pod inside, the device generates wavelenghts of light that are designed to keep the rod cells in the retina active throughout the night, without activating the cone cells, which would keep users awake.

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How does this device work? The rod cells of the retina give us night vision. When it's dark, they become more active, so they can be ready in case we need to get around in the dark. To do this, they need more oxygen. Their demand for oxygen is higher in the dark than in the light. In an eye with retinopathy, surrounding blood vessels can't deliver enough oxygen to keep the rods active, so they deteriorate and die, and the inflammation required to remove the dead tissue also removes cones. Keeping the rods active at night prevents excessive oxygen demand, and indirectly protects the cones. The device even emails your ophthalmologist to report whether you are using it consistently.

Other Innovations in Diabetic Eye Treatment

Users of the Noctura in the United Kingdom, where it is already available, report that it not only prevents the progression of retinopathy, it even improves sight in people who already have advanced retinopathy. It gets results in people who have either type 1 or type 2 diabetes, and many people report that after they use the device they don't need glasses for nearsightedness, or they have been able to keep their driver's licenses, or they have been able to continue working.

Devices like the Noctura 400 offer huge savings in medical costs for the uninsured. The cost of laser surgery for one eye ranges from about $10,000 to about $20,000 in the US (and is similarly expensive in the European Union, although the cost is covered by national health services). The cost of the Noctura is about $25 a week for both eyes. Expect widespread use of the Noctura in the US when it is approved by the FDA. The device will also be popular in countries where a $20,000 bill for laser surgery is simply out of reach for all but the very rich.

In the meantime, a night light actually provides some of the same benefits on a lesser scale. Just be sure your night light emits yellow-green light, not white light or blue. It's the blue wavelengths of light that keep you awake at night.

What are some other innovations in treating diabetic eye disease?

• A new injectable drug called Lucentis may be better than laser surgery for preserving sight in diabetic retinopathy. It preserves peripheral vision, and seems to prevent most (although not absolutely all) cases of advanced complications requiring surgery. An injection into the eye sounds horrific, and when I've had them myself, I was glad I had been given a sedative, but you are given anesthetic eye drops first; there is very little pain from the injection itself although your eye may be irritated (and you won't want to roll over on your stomach in your sleep) for several days.
• Maculopathy, the swelling in retinopathy, is sometimes treated with injections of steroids into the eye. A new product called Iluvien lasts for three years instead of six months to a year, and reduces the number of times you may have to have the procedure.

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• Cataracts are also common in diabetics, and they occur at earlier ages in diabetics, sometimes as early as age 45. New surgical procedures make it possible to replace the lens in the eye the need of stitching the incision. The cut through which the old lens is broken up with an ultrasound probe and to be removed by suction with replacement by a new "origami" lens is so small that it seals itself, and patients can resume their normal activities as soon as they leave the doctor's office. Most insurance plans cover some version of this procedure.