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Treating eye disease before it’s too late

As if an increased risk of heart attack, stroke and amputation wasn’t bad enough for those who fail to heed the treatment regimen for Type 2 diabetes, they also can go blind.

That’s one message from Dr. Saralyn Notaro Rietz, an ophthalmologist who specializes in retinal disease in her nearly 20-year-old practice, Back of the Eye MD, which has offices in Snyder and North Tonawanda.

“It’s a hard disease that affects the organ systems, not just the eyes,” she said, “so these patients have a lot of retina specialist appointments to go to. But they are also dealing with internists, endocrinologists, possibly nutritionists, podiatrists for foot ulcers, kidney specialists for renal failures. The best results are gotten when these problems come to our attention early.”

Notaro Rietz, a Sweet Home High School graduate, holds a bachelor’s degree in biochemistry from the University at Buffalo, where she also attended medical school.

She did her residency in Western New York, and undertook fellowships in vitreoretinal surgery in Raleigh, N.C., and Lexington, Ky.

Most of her patients are 50 or older, and generally face one of three conditions: diabetic eye disease, macular degeneration and retinal detachments. That’s why she has another, similar, message:

“As people age, regular eye exams are important because they help catch diseases as early as possible, when they’re in the most treatable stages,” Notaro Rietz said.

Q. How can somebody with Type 2 diabetes best protect their eyesight?

Number one, be checked, preferably by a retina specialist who’s able to detect disease early and render appropriate treatment. And number two, work closely with a primary doctor or endocrinologist in controlling blood sugar levels.

Q. The retina is in the back of the eye. What does it do?

One of the easiest ways to think about it is sort of film in a camera. It is the structure on which light is focused in the eye. That information is then transferred to the brain. If it becomes detached, then there are errors in that transmission. There are symptoms that oftentimes signal retinal disease: flashes of light, floaters, shadows in vision, sudden blurred vision, distorted vision. If people notice these things, they can come to us directly.

Q. How do you reattach a retina?

Much of it is microsurgery. They can be repaired very often by injecting special gas bubbles into the eye. They can be repaired using a combination of that and what we call a scleral buckle, which is sort of like a belt buckle wrapped around the eye. They can also be repaired by vitrectomy surgery, in which the eye is actually entered, the eye gel is removed and … it’s repaired. The method that’s chosen depends on the type of detachments.

Q. Where are most retinal surgeries performed?

It varies. In the office, I do minor procedures such as laser surgery. We do intraocular injection therapy. More major surgical procedures are done in hospitals or, in some cases, ambulatory surgery centers. Some of the more common ones that require intraocular surgery are retinal detachment surgery and surgery for many diabetic conditions. I do most of my surgeries out of DeGraff Memorial Hospital.

Q. Are there choices we can make to protect our eyesight as we grow older?

There are some. Some of the more common ones are weight control and diet control to minimize risks of Type 2 diabetes. Macular degeneration is largely related to genetics, and runs very strongly in families. Other factors put people at risk: body weight, believe it or not; not wearing sunglasses; blue eye color; farsightedness. Some of those things you can control and some you can’t.

Q. Is there good news for any of the conditions you treat?

Advances particularly with diabetes and macular degeneration have been in medical and non-surgical therapy. Drugs have been developed that are oftentimes administered in an office setting. Medications have been developed to be injected close to the site of disease and, in so doing, deliver better treatment results than what we used in the past. We used to use a lot of laser treatment for some of these conditions.

Q. What do these pharmaceuticals do?

They can help to stabilize abnormal blood vessels that exist in the eye and keep them from leaking blood or fluid into the eye. Depending on the type of leak, if there are leaks in the back of the eye, many things can happen: blurred vision, distorted vision, decreased vision. Those are primarily things patients would notice if blood vessel leakage occurred.

Q. Your husband, Ralph Rietz, is an aerospace engineer. What does your 11-year-old daughter, Tarin, want to be when she grows up?

(With a smile) She wants to be in medicine.


On the Web: Read more about macular degeneration and Type 2 diabetes as they relate to the eye at and