Diabetes and Sight: Keeping A1C and Blood Pressure Levels Normal

David Mendosa Health Guide January 20, 2008
  • The best strategy to save our eyes is to keep our A1C and blood pressure levels as close to normal as possible. But when that strategy doesn't work, we've got to stay ahead of the dangerous changes that can hit us.

    That's the key message that Dr. Niles Utlaut, my
    ophthalmologist here in Boulder, Colorado, told me a few days ago. The good news, he says, is that eye doctors like him have new tools to fight against those changes.

    He had called me into his office after my routine eye exam. I hadn't seen him before.

    Previously I went to a different ophthalmologist here but didn't appreciate the assembly-line approach that that doctor took to seeing his patients. In fact, I only saw that ophthalmologist for about a minute during each visit, because a technician did all the testing. And that testing was inaccurate several times, making me go back again and again for new glasses.

    Dr. Utlaut couldn't have been more different. He runs a quiet, friendly office and does all the testing himself. Except when his patients themselves help out.

    He started with a few turns on the lenses to ask me the routine question, "Which is better: the first one or the second?" Then, he asked me to zero in on the best focus by turning the knob myself.

    In all my years of getting eye exams I had never had the experience. "Patient empowerment!" I exclaimed.

    After my eyes were dilated, Dr. Utlaut had me come back into his office. When he closed the door, I was scared that it was bad news. Fortunately, it wasn't.

    "Your eyes are disgustingly normal," he said with a grin. He had closed the door because before my exam I had told him that I am a journalist who specializes in writing about diabetes, and he wanted to brief me on a couple of recent positive developments in his field.

    I had never heard of either of these developments, and I guess that most of you haven't either. But one or both of these may save your or my vision some day.

    The first one that Dr. Utlaut mentioned was a relatively new imaging technique called optical coherence tomography or OCT. These are big words to describe a non-invasive way that doctors have to look at what we use to look with, our retinas. By using a high level of resolution, OCT is especially good at measuring the thickness of our retinas. It helps
    ophthalmologists like Dr. Utlaut to make early diagnoses of glaucoma, diabetic retinopathy, and macular degeneration. Then, they can treat these conditions before they get out of hand.

    Both eye doctors and cancer specialists are taking advantage of the discovery of a protein called vascular endothelial growth factor, or VEGF. Normal amounts help us repair and maintain tiny blood vessels, like the ones in our retinas. But excessive levels trigger the growth of blood vessels that are more fragile than normal and more likely to leak fluids and bleed -- not something that we want in our eyes. We already have new drugs that counteract this protein, and ophthalmologists are using them to treat not only macular degeneration but also diabetic retinopathy.

  • Dr. Utlaut told me that he used anti-VEGF drugs to treat one patient who had proliferative diabetic retinopathy. "In just four days he had a remarkable recovery."

    I was delighted with my visit to this doctor. He didn't rush me out in the 18 minutes that is becoming all too much of an American medical standard. On the contrary, he took extra time to let me know of these positive developments that I could pass on to you.

    Finally, he said that he wanted to see me again in six months. I was surprised, since he had told me that my eyes are fine.

    "I am more 'mother hennish' than most doctors," he told me. I appreciate his care because I want to stay completely on top of any changes that happen in my eyes.