Retinopathy 101

(Everything you wanted to know about retinopathy, but were afraid to ask)

In my last post I promised that I would share with

Second person, plural

"y’all" -- if you’re from the South,
"yous" -- if you’re from Philly, and
"yinz" -- if you’re from Pittsburgh/Western PA
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you all I have learned about retinopathy and give some details on my own experience with laser therapy for treating retinopathy. This post first goes over what I’ve learned and provides some good resources for more information that I’ve found.

There are several stages/types of diabetic retinopathy. The most common is known as nonproliferative diabetic retinopathy or “background” retinopathy. This is when the tiny capillaries in the retina start to weaken and show signs of

Or:

Small bulges, like an over-inflated balloon or bike tire.
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microaneurysms and perhaps even small blot hemorrhages when these microaneurysms rupture. This shows up in almost all diabetics after 20 years duration. Things can remain stable at this stage for a very long time, and the risk of progression of the retinopathy can be greatly reduced with tight blood sugar control.

The next stage in the progression of the disease is when these tiny capillaries become blocked, and show signs of retinal

Or:

An inadequate supply of oxygen.
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ischemia in the form of “cotton wool spots.” This diminished oxygen flow to the retina then triggers the growth of new capillaries. This new capillary growth is called “neovascularization” and this is when nonproliferative retinopathy moves into the proliferative retinopathy realm.

One would think that getting more blood flow to a starving region of the body would be a good thing, but

It's no good for cancer, either

You don’t want to feed a tumor, though sometimes the body will do just that.
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unfortunately that isn’t always the case. These new capillaries tend to be fragile and nebulous, thus they are even more prone to leaking than the microaneurysms. The growth and hemorrhage of these new capillaries are what increases the risk of having significant vision loss. Sometimes the loss can be temporary and the blood from the hemorrhage will clear over time, but other times it can be permanent.

Another type of retinopathy is called diabetic

Defns:

The macula is the central part of the retina and is the part of your retina responsible for (you guessed it!) your central vision. Edema simply means swelling.
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macular edema. This can happen at either the nonproliferative or the proliferative stage and lead to separation between the retina and the back of the eye, which again leads to vision loss.

Laser therapy has been used very successfully to treat diabetic retinopathy. Having laser treatment, however, is essentially doing some controlled damage to hopefully prevent significant future vision loss. Studies have found that laser treatment for proliferative diabetic retinopathy reduces the risk of significant vision loss by about 50%. My understanding is that the risk over a two year period of having a significant hemorrhage resulting in some temporary or potentially permanent vision loss is about 7%, and laser treatment cuts this risk in half.

There are a few different types of laser treatment used, but for proliferative retinopathy, the most common procedure is called “panretinal photocoagulation“ (yep, that’s a mouthful). This procedure basically involves shooting a little over 1,000 laser burns in a grid-like pattern in the periphery of your retina (away from the macula where the central vision takes place). There are two reasons for this: First, the lasers cutoff and cauterize the new capillary growth. Second, the laser burns hopefully slow down or stop more capillary growth. This happens because the laser actually destroys bits of your retina, which then reduces the overall oxygen demand of the retina (if there’s less there, there’s less demand for oxygen). This should then decrease the signals being sent to create new capillaries. At least that’s the theory.

The most common side effects listed for panretinal photocoagulation are “decreased night vision”, and “decreased peripheral vision”. These two phrases are SO frustratingly vague to anyone about to under go said treatment, it’s enough to drive one bananas with fear. In my next post, I’ll go over what the actual treatment was like for me and describe the side effects I’ve been experiencing.

Here are some really good resources that I’ve found on retinopathy and diabetes complications in general. (I hope you find this useful, and not just a scary lecture).

The Basics

NIH
Mayo Clinic

Current Research

Focus on Retinopathy
Quality of Life after Laser Treatment

Diabetes Complications in General

Pathobiology of Diabetic Complications
Diabetic Microvascular Complications

Let's see, where to begin?

So... the title “Born Again Diabetic” (which, I love) suits me perfectly.

For the past 27 years, I’ve been nothing but average (if not worse) in terms of the care and upkeep of my diabetes. My A1c readings over the last 7 years or so have had a

Yes

I have actually plotted them in Excel and can clearly see that my control was worse around the Winter holidays (aka: food fests) and better in the Spring/Summer when I'm generally more active.
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nice cyclical pattern with a range of 7.9 to 9.2, and I honestly have no idea what they were for the 20 years before that, but I’m assuming about the same (or again, if not worse). This past year, however, I've made tremendous improvements in my control and am really excited about that. This previously lackadaisical management, however, may be catching up with me (and it scares the shit out of me).

Anyway, a month ago I was told by my ophthalmologist that my background, nonproliferative diabetic retinopathy (which had been first diagnosed about 5 years ago and had remained relatively stable) had grown

Well, actually

New capillaries, not legs (though 'legs' works nicely with the whole 'stepping up' analogy, huh?). This new capillary growth is known as 'neovascularization' in medical lingo. So, that's a nice big word I've added to my vocabulary recently. Gotta love opportunities to learn new things!
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legs and stepped up into the proliferative category. He (of course) told me that I would need laser treatment and while I was able to hold myself together in his office, I started to lose it in the elevator ride down to my car (where I then had a complete and total melt-down on an excruciatingly sunny spring afternoon).

After that, I pulled myself together, waited for my eyes to un-dilate (re-constrict?) and went home to start coping with this news. (actually, my melt-down was probably the absolute beginning of my dealing with the news, I guess, huh?). So for the following two weeks, I researched all I could about retinopathy and laser treatment. I felt a little more in control of the situation by learning as much as I could about it (even though I know this is a somewhat false sense of control, it still made me feel better, and it was the best coping mechanism I could come up with on such short notice).

Well, I had the procedure done in my left eye two weeks ago and am scheduled to have the next laser treatment for my right eye a week from today (Monday, the 5th). I had originally planed to post all about what I've learned about retinopathy, the details of what the procedure was like, the side effects I've experienced, and share some good resources on retinopathy and laser treatment. Unfortunately, after I'd written all this down, I came up with something like 6 pages worth of story-time (i.e., too much, and way too disorganized). Thus, I'll post those details later, once I've editted my writing down a wee-bit better.

(Foregive me, I'm new to this posting business).

And PS, I know the title of this post is a really bad pun, but I couldn't help myself.

Please allow me to introduce myself...

Hi, I’m Kevin.

I used to be a lurker in the Diabetes OC, but now I’m a blogger -- just like you! (unless you’re a lurker in the Diabetes OC (like I used to be), or a random friend or family member I've gotten up the nerve to share this little web page of mine with).

I’ve been reading many of the blogs in the Diabetes OC for many months now and have seen a lot of these Memes, Interviews, and Top 5 Lists out there and I feel like I’ve had a chance to get to know you a lot better than you’ve gotten to know me through my occasional comments. So, I’ll just try to give a brief overview of who I am to kick things off:

I’m a type 1 diabetic. I was diagnosed when I was 5-years old (I think it was in May of 1979 (I was too young to remember such details, and my parents didn’t keep the best records)) and so that makes it 27 years now and therefore makes me just shy of 33 years old. Q.E.D. (I’m a geek).

I’m a programmer/analyst for a government agency (I can’t tell you which, or I’d have to

Not Really

But our media relations folks are pretty strict about us remaining anonymous government employees.
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kill you). I work on building public policy simulation models and have degrees in demography and economics. So I spend my days writing Fortran and SAS programs (and I must reassert: I’m a dork).

I don’t follow sports in any way, shape, or form really, and I find that this causes conversational difficulties for me at times – particularly when I’m meeting a new group of men at a party, for instance.

I play guitar, though not very well, but it’s certainly something that I can (and do) spend hours on end doing. And if you couldn’t tell from the subject line, music really floats my boat / blows my hair back / rocks my socks / etc. / etc. / etc.

While I’m not a huge Rolling Stones fan per se, I do think "Exile on Main Street" is a truly exceptional album and have been told repeatedly by some friends that I would really love "Beggars Banquet" and "Let it Bleed." I would say my top three bands are the Beatles, Phish, and Wilco. I have been to about 30 Phish shows from say 1992 through 2002, and while I’m kinda sad that they’re no longer together, I have to admit that they were declining.

But I’ve recently become totally hooked on quite a few

Worth Checking Out

The New Pornographers
Death Cab For Cutie
Postal Service
Architecture in Helsinki
The Arcade Fire
Sufjan Stevens
Wolf Parade
Clap Your Hands Say Yeah
Stars
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indie pop bands – There's so much great music out there these days (and surprisingly a lot of it comes from Canada), that it's a little overwhelming.

I wish to learn Spanish.

I've traveled to England, Japan, Guatemala, and Costa Rica, but haven's seen a whole helluva lot of the US.

I have a lovely wife named Megan who is extremely generous and thoughtful and I am not sure what or where I’d be without her (think Beach Boys – at least, that’s what pops into my head). And on the animal front, we have a little Beagle/Basset hound named Jorge that we adore.

We live in a little hippy suburb outside of Washington DC, though we used to live in the greatest neighborhood on the planet: Dupont Circle (don’t you just love biased hyperbole?). The transition to a suburban lifestyle where you have to drive to everything was (and still is) a bit difficult for us to get used to. We didn’t have a car for the past ten years and now we have two(!). Life is truely nicer when you can walk to work, the grocery store, or restaurants with relative ease.

(In case you haven't been able to tell from the blog title and my writing so far, I like parentheses and tangents and

If you like footnotes, too

You should definately check out two of my favorite authors/books:
David Foster Wallace - "Infinite Jest" and
Nicholson Baker - "The Mezzanine"
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footnotes and

And as Edward Tufte said:

"Notes belong in the margin, where God intended them to be."
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sidebars (I sometimes like to nest them, too (and although these diversions might be difficult to read or follow at times, I find it’s the best way to express my thoughts (sometimes)))).

I’m kinda out-doorsy. My dad taught me to fly-fish well before "A River Runs Through It" and Brad Pitt made it popular, though I'm lucky if I actually get myself out on a stream more then a handful of times per year. I used to rock climb and mountain bike in high school and college, but now I’ve got a desk job and only get out

aka: Car camping

Tents are literally feet from our cars, meals usually include a large salmon, and there's french press coffee for breakfast (though I'm not a coffee drinker myself).
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Gucci camping with friends a couple times a year as well.

That’s a lot to read, but it paints me fairly accurately in broad strokes: (diabetic; likes music; plays guitar; likes tangential, stream of conscious writing, married and has a dog; tries to learn Spanish; and was totally excited when he stumbled upon the Diabetes OC (and sometimes randomly writes in the third person)).

So… I look forward to continuing to read your blogs and also to sharing my thoughts on life in general and life with diabetes specifically, getting your feedback, writing back to your feedback, and having… like, you know… a conversation…yeah, yeah… and getting to know you better… and you getting to know me better… and, yeah, yeah… that’s the ticket!