After surgery for diabetic retinopathy, Berneice Fischer is looking forward to seeing her family. Fischer is a mother and grandmother who worked as an apartment manager and enjoyed sewing. She was diagnosed with type 2 diabetes in 1991, but with medication, she had few diabetic complications.
In 2003, she began having difficulty with her vision blurring. Her eyes occasionally hurt. Fischer attributed her problems to aging and reluctantly retired. Her optometrist diagnosed her with diabetic retinopathy. Weakened blood vessels in her eyes had scarred her retinas. An estimated 40-45 percent of people with diabetes develop diabetic retinopathy. Often, as in Fischer’s case, patients have no symptoms until their vision is damaged.
The optometrist referred Fischer to Rajendra S. Apte, MD, PhD, Washington University ophthalmologist at Barnes-Jewish Hospital. Dr. Apte, who sees patients at the Barnes Retina Institute, specializes in medical and surgical diseases of the macula, retina and vitreous, including diabetic retinopathy, macular degeneration and retinal detachment. Testing showed damage to the blood vessels in Fischer’s retina had caused leakage and hemorrhaging, substantially increasing her risk of blindness.
The good news for patients like Fischer is that doctors now have an arsenal of treatments to stabilize the disease process.
"In some cases, we can actually improve a patient''s vision," Dr. Apte said. "That was unheard of 20 to 25 years ago."
Laser treatments, which halt the disease process in most patients, followed by steroid injections into the eye, didn’t work for Fischer.
"Fortunately, we have many options available for people with diabetes," Dr. Apte said. "Not many centers in the Midwest have the caliber of care available at Washington University and Barnes-Jewish Hospital. Our patients also have the option to participate in clinical trials that evaluate medicines of the future."
Fischer’s best option, Dr. Apte said, was a vitrectomy, removal of the vitreous gel in the eye.
The surgery not only stabilized Fischer’s vision but noticeably improved it, and Dr. Apte thinks she may notice additional improvement after she has surgery for a cataract unrelated to her diabetes. An OCT scan of her eye, similar to an MRI of the body, shows the leakage and swelling in her retina has now largely resolved. And treatments now in clinical trial, such as injection of pharmacologic agents into the eye, show great potential for improving vision in diabetic patients.
Dr. Apte recommends all people with diabetes try to control their blood sugar in order to cut down on the risk of complications, have regular evaluations by an ophthalmologist and see a specialist for early treatment and intervention when retinopathy does appear.
Without the specter of blindness looming in her future, Fischer looks forward to seeing her children and grandchildren for a long time to come.