Being Well 711: Diabetic Eye Disease


[music playing]
>>Lori Casey: Ahead on this edition of Being Well, it’s
a new guest on our program. Dr. Ryan Pine of Advanced Ophthalmology in Charleston will
be here. We’ll be talking about diabetic eye diseases such as retinopathy. Dr. Pine will
explain the stages and the treatment. We’ll also touch upon cataracts, glaucoma, and we’ll
find out if those things called floaters can be dangerous. That’s all just ahead; so don’t
go away. [music playing]
>>Female Speaker 1: Production of Being Well is made possible
in part by Sarah Bush Lincoln Health Systems; supporting healthy lifestyles, eating a heart-healthy
diet, staying active, managing stress, and regular check-ups are ways of reducing your
health risk. Proper health is important to all at Sarah Bush Lincoln Health System; information
available at sarahbush.org. Alpha-Care specializing in adult care services that range from those
recovering from recent hospitalizations to someone attempting to remain independent while
coping with a disability, chronic illness, or age related infirmity. Alpha-Care, compassionate,
professional home care. Additional funding by Jazzercise of Charleston.
>>Lori Casey: I’m here with Dr. Ryan Pine of Advanced Ophthalmology
in Charleston. Dr. Pine, let’s get started with our discussion. Tell us a little bit
about an ophthalmologist and what you do.>>Dr. Ryan Pine:
Okay, ophthalmologists are medical doctors who are trained to treat diseases of the eye.
We go to medical school to learn the whole body and then after medical school, we kind
of branch off through residency to be going to more specialized training of the eye, the
visual pathway, diseases that effect it, and ways to treat them.
>>Lori Casey: Okay, so what– when you talk about diseases
of the eye, what kinds of things do you see in your practice?
>>Dr. Ryan Pine: Most commonly, cataracts, diabetes, diabetic
eye disease, glaucoma, crossed eyes, macular degeneration both wet and dry, other retinal
diseases.>>Lori Casey:
Okay, so do you actually– an optometrist– just explain real briefly, what’s the difference
between an optometrist and an ophthalmologist because I think a lot of our viewers probably
have that same question.>>Dr. Ryan Pine:
Sure, sure, I get that question a lot. Optometrists are– go through a four-year school looking
directly at just the eye with treating the refractive state of the eye such as glasses
and contact lenses. They’re also trained to screen for diseases of the eye and have some
limited treatment roles. We’re lucky to have some good optometrists in our community here.
>>Lori Casey: Okay, so we want to get back into some of
the common ailments that you treat in your office, and one that seems to be that you
see a lot of is you see a lot of our diabetics. Why is it important for diabetics to have
their eyes checked?>>Dr. Ryan Pine:
I think it’s– as an ophthalmologist should be involved with every diabetic patient’s
care because it’s part of the full treatment care team, if you will. What– when we look
in the back of the eyes, and if we see changes in the back of the eye that are from diabetes,
it’s important to know that those changes aren’t limited to the eye, those are going
on elsewhere in the body. As eye doctors, we get to actually see blood vessels, where
other doctors have to inject dye into the veins to see vessels. So, we cannot only help
with the vision, but we can help with the other physicians knowing how the management
is going and treatments are going.>>Lori Casey:
So, what kinds of things do you see when you look in the back of an eye of a diabetic?
>>Dr. Ryan Pine: Sometimes nothing, sometimes things look good
if there’s really good control. Other times, we can see early cataracts form, we can see
changes in blood vessels that can lead to bleeding or swelling in the back of the eye,
new blood vessels growing in the back of the eye, which we never want to see.
>>Lori Casey: Why are diabetics more apt to have eye problems
than non-diabetics?>>Dr. Ryan Pine:
Well, I think– I think to understand that you kind of have to understand a little bit
about how diabetes affects the eye, and how diabetes works in general. Diabetes is obviously
a disease where the sugars in the blood stream are high. As those sugars float through the
blood stream, they cause changes and they deposit into the walls of the blood vessels,
which leads to hardening and narrowing of the blood vessels. A hard and narrow blood
vessel doesn’t carry as much blood, which doesn’t carry as much oxygen. And the back
of the eye, in particular, is a highly metabolic state; it needs a lot of oxygen. And so, when
you start to see changes in the blood vessels when we dilate and look in the back, these
changes can be little out pockets of the blood vessels or those little, called micro-aneurisms,
those little micro-aneurisms can burst or bleed. They can leak fluid or blood or fats
into the retina. In a severe state, where the eye is kind of starved of so much oxygen,
if you will, the eye will tend to grow new blood vessels to bring more oxygen, which
sounds great, but those new blood vessels are very destructive.
>>Lori Casey: Okay, and why is that? Because that does sound
like a good thing.>>Dr. Ryan Pine:
It does, the new blood vessels, they’re not as good as the ones you’re born with, they’re
very leaky and they tend to close off and scar and pull on the retina and cause retinal
detachments or large bleeds in the back of the eye.
>>Lori Casey: So, is this, what we’re talking about diabetic
retinopathy, is that what we’re really talking about here?
>>Ryan Pine: It is, and that kind of goes through the stages.
Early changes from diabetic retinopathy may be just a few little micro-aneurisms here
and there. Or a few little spots of bleeding. The more numerous those spots are and the
location of those spots kind of quantify the stage of retinopathy that you have. In ophthalmology,
we consider it non-proliferative or proliferative diabetic retinopathy. Non-proliferative just
means there’s no growth of blood vessels yet, and that’s subdivided into like mild, moderate,
and severe. With proliferative diabetic retinopathy, it’s the more advanced stage where new blood
vessels are growing and have a very high potential that can cause vision loss or blindness.
>>Lori Casey: So, are there some sort of symptoms if someone’s
sitting at home, like can they actually tell through their vision that they have retinopathy?
>>Dr. Ryan Pine: Unfortunately, in the early stages, no. Most
patients are unaware when I tell them there’s some changes in the back of the eye. As- if
there are a little bit more advanced stages, they may notice some blurring of the vision,
maybe blurring of the central vision. Sometimes, that just comes from cataracts, sometimes
it comes from swelling or bleeding in the back of the eye.
>>Lori Casey: So, when you look at your diabetic patients
who typically is at the greater risk for the more advanced retinopathy? What kind of diabetic?
>>Dr. Ryan Pine: Well, type one and type two are both equally
at risk.>>Lori Casey:
Okay.>>Dr. Ryan Pine:
The pregnant ladies who are diabetic have an increased risk of having either findings
of retinopathy during their pregnancy or should they have retinopathy prior to pregnancy,
it can worsen. Essentially, it comes down to, the longer you’ve had diabetes, the higher
your risk of having findings of it.>>Lori Casey:
So, I know that there is this connection between A1C level and retinopathy. But first, talk
about what A1C is.>>Dr. Ryan Pine:
Sure, hemoglobin A1C is a blood draw or a blood test that your primary care doctor or
who’s managing your diabetes will check for you every three to four months. That lab test
looks at changes in the red blood cells that are caused by high sugar levels surrounding
them. We know that a normal hemoglobin A1C is around 6% or less. In diabetics, it’s often
a little bit higher.>>Lori Casey:
Okay.>>Dr. Ryan Pine:
The reason it’s important, in my opinion, the reason patients, I think, should make
a goal of knowing what their A1C is and trying to keep that number low, is because that three
month average of blood sugars, we have studied that in ophthalmology wondering who’s at risk
for going blind? And what we found was patients whose hemoglobin A1C was less than 8%, have
a significant decreased risk of going blind. So, the– it’s not to say 7.9 is as good as
6.9, but I think a target of at least less than 8%, at least early on in diabetes, is
a great goal.>>Lori Casey:
So, for someone who has diabetes, they want to be less than 8%, is that what you said,
or what’s a level?>>Dr. Ryan Pine:
It is tailored in a little bit.>>Lori Casey:
Okay.>>Dr. Ryan Pine:
Individually and the primary care doctors and endocrinologists are very good at that.
But in my opinion, less than 8% is a goal that everyone should have. Some doctors prefer
their patients closer to 5 and a half to 6% range, some think it’s okay for them to be
in the upper sixes.>>Lori Casey:
So, what do you, as the ophthalmologist, when you get those A1C results, how do you use
that information?>>Dr. Ryan Pine:
Well, I typically, I don’t get the results sent to me, I usually ask the patient. And
that’s always a telltale sign of how involved in their care they are.
>>Lori Casey: Okay.
>>Dr. Ryan Pine: Some have no idea what an A1C is.
>>Lori Casey: Okay.
>>Dr. Ryan Pine: Some have no idea what the number is, and
others know it very well. And so, I typically try to explain to them about the hemoglobin
A1C and that a target of less than 8% is important for the vision and explain why as we just
discussed.>>Lori Casey:
if you have someone– let’s talk about treatment, if someone does have diabetic retinopathy,
how do you, obviously determine the stage, then how you do you determine the course of
treatment for them?>>Dr. Ryan Pine:
It can range very much accordingly to what we see in the back of the eye. Very early
stages, we may just observe because they’re reversible in early stages. If the patient
maybe increases their overall activity and their management or their management.
>>Lori Casey: The things that they should be doing to manage
their diabetes in the first place.>>Dr. Ryan Pine:
Yeah, helping themselves out a little bit, sometimes. The– once the swelling of the
back of the eye happens where it’s limiting the vision, there are a couple different things
that we can do, we can inject medicines into the back of the eye that will help get rid
of the swelling. We can use certain lasers to the back of the eye to help prevent those
blood vessels that are bleeding to help them dry up. In the more severe, advanced stages
like proliferate diabetic retinopathy, we use lots of lasers and combinations of injections
and sometimes, even surgery.>>Lori Casey:
Are most of those treatments things that are done in an ophthalmologist?s office? Or do
you go to a hospital?>>Dr. Ryan Pine:
Most are done in the office. I mean, surgery’s obviously done in a hospital, but most of
the stuff that we’re able to do, we’re able to do in the exam chairs.
>>Lori Casey: So, if someone has maybe the lasers or the
injections, does the– are the results, do they take a couple weeks to take affect? Or
is it kind of an instant sort thing?>>Dr. Ryan Pine:
It’s definitely not instant.>>Lori Casey:
Okay.>>Dr. Ryan Pine:
It’s definitely not instant, but it does take, oftentimes, several weeks or months to get
some improvement. But at the same time, the patients and the doctors are working together
over those next few months; we make things a lot better.
>>Lori Casey: Okay, if someone has the treatment, does that
mean they can’t get it again?>>Dr. Ryan Pine:
Unfortunately, no. The underlying disease, if it’s under better control, oftentimes,
a few treatments may be all they need. To often not, it’s a battle, it’s a frustrating
disease for the patients and for the doctors, but working together, we can make things better.
>>Lori Casey: Do people– if they have it, do they get it
always in both eyes or can it just happen in one? Is it–
>>Dr. Ryan Pine: It’s usually in both eyes, maybe the severity
is slightly different between the two eyes, but if it’s looking like it’s just in one
eye, then there’s some other things that I would worry about rather than just diabetes.
>>Lori Casey: Okay, if it’s left untreated, what sort of–
what happens?>>Dr. Ryan Pine:
Patients lose a lot of vision, and most of the time, it’s extremely blurry vision that
glasses or contacts won’t correct or cataract surgery wouldn’t correct. In worse case scenario,
patients can go completely blind by having an untreated proliferative disease. And it’s–
fortunately we don’t see that much nowadays because we have very good treatment options,
we have very good medicines, and a very good diabetic care team, if you will.
>>Lori Casey: Is there any– I want to talk a little bit
about cataracts and glaucoma because I know cataract is something you deal with. Are there
other things that you wanted to address in terms of retinopathy because people–
>>Dr. Ryan Pine: Well, it’s along with diabetes, there’s a–
there is kind of a diabetic eye disease label, which diabetic eye disease not only includes
diabetic retinopathy, but it also included cataracts, and glaucoma. Patients, who are
diabetic, get cataracts at a much younger age, sometimes in the 30s, 40s, 50s. Patients
who are diabetic have twice the risk of developing glaucoma, and we think that’s due also to
the blood flow compromise to the optic nerve, just like the blood flow changes in the retina.
So, it kind of makes sense.>>Lori Casey:
So, they’re at risk for two other things.>>Dr. Ryan Pine:
Absolutely, absolutely, and that’s part of the normal screening that we all do on every
exam.>>Lori Casey:
Okay, I was going to ask when someone- a diabetic- sees their ophthalmologist, what sort of tests
do you run?>>Dr. Ryan Pine:
Well, first of all, we have to know your vision because that’s why you’re here to see us.
And no matter what I tell you, what you want to do is see better so we have to know how
well you’re seeing. And then, we will look at the front of the eye with our microscopes
or our slit lamps, shine some bright lights at you, check your eye pressure which is part
of the screening for glaucoma. And then, dilate the eyes, which is the most important for
a diabetic. Every diabetic patient should have at least one dilated eye exam per year.
And then, depending on the findings, we reserve the right to shorten that.
>>Lori Casey: But from what I understand, a lot of those
tests, compared to some other tests that we have, it’s this fairly non-evasive.
>>Dr. Ryan Pine: Absolutely, yeah I’m sure it’s not much fun
to get a really bright light shone in your eye, but–
>>Lori Casey: Or that puff of air, no one likes that.
>>Dr. Ryan Pine: Yeah, we don’t do that at our office, luckily.
But the– it is a lot of bright lights and me poking my fingers around on your eye, for
sure. So, but it’s all very worth it in the end because oftentimes, I can find out a patient’s
diabetic before they ever knew, and so, we can see changes in the back of the eye and
then start doing some of the investigations with the primary care doctors and actually
determine patients are diabetic and save their eye sight.
>>Lori Casey: Are diabetics shocked or surprised that they
may lose their eyesight? We often, you know, talk about diabetes on this show and it’s,
you know, losing of limbs and diabetic ulcers and things. Where does– are they surprised
about the eye– loss of vision?>>Dr. Ryan Pine:
I think, probably not surprisingly the one sense that most people tell me that they never
want to lose is their eyesight, and so, as soon as they hear that their eyesight can
be affected or they can lose eyesight from this disease. Oftentimes, it gets them into
the office. So, not so sure if it’s surprised, sometimes there’s some denial, but it’s not
usually surprise.>>Lori Casey:
So, it sounds like if you have those early stages of retinopathy, keeping your diabetes
under control is the way to–>>Dr. Ryan Pine:
Absolutely, and everybody talks about diet and exercise, which are extremely important
to do. That lowers your sugars without any medicines. Oftentimes, patients who are diabetic
also have high blood pressure and high cholesterol. You take diabetes, high blood pressure, and
high cholesterol and you have those things together and that all equals damage to the
blood vessels. And those damage to the blood vessels that happen to the back of the eye,
they’re going on elsewhere in the body, leads to early heart attacks or early strokes, not
just vision loss. So, it’s important all around.>>Lori Casey:
It’s kind of a cumulative effect.>>Dr. Ryan Pine:
It is, it is.>>Lori Casey:
I want to spend these last 10 minutes talking about cataracts and glaucoma, because that’s
something a lot of people deal with, whether they’re diabetic or not. Let’s talk about
what is the difference between cataract and glaucoma?
>>Dr. Ryan Pine: Pretty significant difference, the cataracts
develop inside the lenses in the eye, the human lenses. It’s kind of behind the colored
part of the eye, the iris. It’s about the size and shape of a chocolate M&M. And so,
I describe it to my patients that that chocolate used to be crystal clear and over time, those
lenses proteins start to get cloudy. Once it gets to a certain stage, we can kind of
remove the candy shell of the M&M, take the chocolate out, or the cataract out, and replace
it with an implant, and it gets patients seeing much better. In diabetic patients, those changes
to the lenses happen earlier, as the sugars go up and down in the blood stream, the sugars
cause changes within the lenses that form the cataract faster.
>>Lori Casey: Does everybody– can everybody get cataracts
over time? I mean, is that just a natural part of aging?
>>Dr. Ryan Pine: It is.
>>Lori Casey: Okay.
>>Dr. Ryan Pine: I tell patients, if you live long enough,
you get them. If you live long enough, you’ll need them taken out.
>>Lori Casey: I know a lot of people have had the cataract
surgery, so it seems like a fairly common thing.
>>Dr. Ryan Pine: It is, it is. And you can have a cataract
as a newborn, and in the teenage years, and late elderly patients. And so, it can happen
at any walk in life, and having a cataract doesn’t always mean you’re old. I know a lot
of patients feel that way.>>Lori Casey:
Can you do anything to prevent them?>>Dr. Ryan Pine:
Not necessarily.>>Lori Casey:
Okay, let’s talk about glaucoma, that’s another one.
>>Dr. Ryan Pine: Glaucoma is a very broad subject that essentially
is oftentimes damage to the optic nerve, which causes permanent vision loss. The optic nerve
is an extension of the brain and just like the spinal chord, if you injure it, sometimes
it’s hard to get that function back. And it’s the same way with the optic nerve. Oftentimes
in glaucoma, there’s associated pressure in the eye that can be oftentimes high, not always,
but oftentimes high. And so, sometimes just lowering the pressure in the eye with drops
or surgery or lasers can keep stress off the optic nerve and keep damage from happening.
>>Lori Casey: So, when I think of like pressure in the eye,
like is it– it’s pressing outwards? Or what’s creating the pressure? Is it fluid?
>>Dr. Ryan Pine: It is fluid.
>>Lori Casey: Okay.
>>Dr. Ryan Pine: The eye has essentially two chambers, the
front chamber is filled with a water called aqueous and the back chamber’s filled with
a jelly called vitreous. It’s the front chamber that we think has the most pressure relation
to glaucoma because that fluid inside the eye, which is different than tears, this is
inside the eye, is always made and turned over. So, there’s a faucet where the fluid
comes from and there’s a drain where that comes from. And sometimes, it’s just an imbalance
in that situation that leads to an increased pressure.
>>Lori Casey: Okay, and if you had been to the eye doctor
over the years, some places still use it, that puff of air. But you said there’s different
ways now of testing that.>>Dr. Ryan Pine:
Sure.>>Lori Casey:
It’s not an awful thing, but it’s just–>>Dr. Ryan Pine:
I understand, I hear that a lot. That’s not going to be a puff of air? So, no there are
multiple ways to check the intraocular pressure, but the gold standard is called applanation
tonometry, where we after applying some anesthetic to the eyes so that you don’t feel it, we
actually lightly touch or indent the front of the eye. And that’s the gold standard to
measure intraocular pressure.>>Lori Casey:
You talked about, for cataracts, you can replace, you get rid of the cloudiness. What is the
treatment for glaucoma then?>>Dr. Ryan Pine:
The treatment for glaucoma ranges depending on– there are various types of glaucoma.
And it depends on maybe what the cause of the glaucoma is. Sometimes a simple laser
can prevent glaucoma; other times you need eye drops to keep the pressure low. Eye drops
work by either turning the faucet down or opening up the drain. Then, there’s lasers
that can help on the drain. In some advanced cases, you actually have to have surgeries
to create additional pathways for fluid to come out of the eye.
>>Lori Casey: I wanted to ask you, I looked this up this
morning, this– what are floaters in the eye? I know a lot of people have probably seen
that stuff floating in their eye.>>Dr. Ryan Pine:
The little gnat that you swipe at?>>Lori Casey:
Yes, what is that?>>Dr. Ryan Pine:
Floaters come from the back of the eye where, like I just mentioned, the two chambers, the
water part in the front and the jelly in the back. The jelly in the back starts to kind
of ball up and clump on itself as you add candles to your birthday cake. And so, typically
those little– when those little opacities get within the vitreous jelly, as light comes
through there, it hits that little opacity and then it casts a shadow on your retina.
And so, you’re seeing the shadow of that.>>Lori Casey:
Okay.>>Dr. Ryan Pine:
Kind of like the sun and the clouds and the earth.
>>Lori Casey: Is it dangerous? Or is it something we should
be worried about?>>Dr. Ryan Pine:
Well, just a few floaters here and there are very common. What we worry about when we think
of floaters is a whole rush of them, almost like a swarm of bees or somebody shook up
a snow globe. Oftentimes, that bunch of floaters is associated with bright flashing lights
like lightning and then maybe in a change in the peripheral vision. And those things
we do worry about as causing some damage to the retinas, such as a retinal tear or retinal
detachment. And so, I think any time you have new floaters, it’s always good to have your
eyes checked. If you’re having flashing lights floaters and a change in your vision, then
it’s more of an urgency.>>Lori Casey:
I was just going to ask, what are some warning signs of severe, you know, eye issues. You
know, we know about the signs of stroke and heart attack and you know, act now. What are
some eye things that we– you’ve mentioned a couple of them that we should really keep
track of for either us or someone in our family?>>Dr. Ryan Pine:
Well, I think the flashing lights floaters and a change in peripheral vision, those three
things together is a pretty ominous sign. Other things, if something straight doesn’t
look straight, like there’s a bend in a telephone pole that you know is not there or the road
curves. If you’re all of a sudden, you’re vision’s okay but then all of a sudden you’re
seeing two images of something, that can be alerting, so.
>>Lori Casey: All right, I want to ask the ophthalmologist
here, what are things that you do as an ophthalmologist to protect your own eyes? You know, I’ve asked
the dentist, what do you do to take care of your own teeth, what do you as an ophthalmologist
do to take care of your own eyes that maybe we should be doing as well?
>>Dr. Ryan Pine: Well, I will say that the first thing I do
is try to eat healthy and exercise because I think that not only helps the eyes, it helps
the whole body. After that, wearing a hat and sunglasses are probably the most thing
you can do at a younger age to protect you from– we think UV light and damage over time
has a role in not only cataracts, but macular degeneration and other things. And so, I think
wearing a hat and sunglasses and just trying to take good care of yourself in general will
make a big difference.>>Lori Casey:
So, do you recommend– and I know you said you have some small children, do you recommend
for kids getting them wearing sunglasses when they’re outside?
>>Dr. Ryan Pine: Yeah, my boys love it. They won’t go outside
without them for some reason, so.>>Lori Casey:
Well, they look cool that way.>>Dr. Ryan Pine:
And they see dad in them, I think. But, yes, I think protecting the eyes, just like sunscreen,
you go out, sunscreen for the skin, and sunglasses for the eyes I think is great.
>>Lori Casey: All right, is there anything else that you
want to address that we haven’t got to yet?>>Dr. Ryan Pine:
I don’t think so, we touched on a lot of stuff.>>Lori Casey:
We did.>>Dr. Ryan Pine:
I appreciate it.>>Lori Casey:
Well, we’re going to have you back again because there’s so much information out there and
I think when our eyes are fine, which they are most of us for the most part, it’s not
a problem. But boy, like you said, when you risk maybe losing your vision, it’s a wake
up call.>>Dr. Ryan Pine:
Absolutely, absolutely. That’s what we’re here for.
>>Lori Casey: All right, thank you so much for coming by
Being Well, I appreciate it.>>Dr. Ryan Pine:
You’re welcome, thank you very much. I appreciate it.
>>Female Speaker 1: Being Well is also available online at our
YouTube channel, youtube.com/weiutv. Just look for the Being Well playlist. Here, you
can view current, as well as past, episodes.>>Lori Casey:
Well, we’re out of time for this edition of Being Well. Thanks so much for joining us
and we’ll see you next week.>>Female Speaker 1:
Production of Being Well is made possible in part by Sarah Bush Lincoln Health Systems;
supporting healthy lifestyles, eating a heart-healthy diet, staying active, managing stress, and
regular check-ups are ways of reducing your health risk. Proper health is important to
all at Sarah Bush Lincoln Health System; information available at sarahbush.org. Alpha-Care specializing
in adult care services that range from those recovering from recent hospitalizations to
someone attempting to remain independent while coping with a disability, chronic illness,
or age related infirmity. Alpha-Care, compassionate, professional home care. Additional funding
by Jazzercise of Charleston. [music playing]

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