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WNY retinal surgeon talks diabetes, macular degeneration

Aging isn’t for wimps – and I’m talking about just the eyes here.

Aside from the fact that almost everyone in The Buffalo News newsroom wears glasses or contact lenses, there are other visual challenges many people among us will face along with the blessings of older age.

“Eyes age like many other parts of the body,” Dr. Saralyn Nataro Rietz told me earlier this week during an interview for this weekend’s In the Field feature for WNY Refresh.

“Starting from the inside going in, lids often begin to droop. Our natural lenses cloud and become cataractous. Dryness becomes a problem; we make fewer tears. Irritation can become very significant if it’s prolonged. Retinas can become detached and that’s a very mechanical thing, it’s not a disease.

Then there are diseases that become part of the picture for some – particularly those with diabetes.

As a retinal – back of the eye – specialist, Nataro Rietz tends to treat mostly patients who are 50 or older, and generally face one of three conditions: diabetic eye disease, macular degeneration and retinal detachments.

All can lead to severe limitations in vision.

She talked about that in the Refresh print piece. Below are some excerpts that pertain to the three conditions I didn’t have room for in print.

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.

How would your workload break down compared to a generalophthalmologist?

It’s a completely different field. It is its own subspecialty. There are others: the glaucoma specialty, the cornea specialty. The eyes a small organ but has a lot of parts. A general ophthalmologist may concentrate most of his or her time on conditions such as cataracts, some glaucoma. A retina specialist spends most of his or her time dealing largely with conditions that affect the back of the eye, or the retina. … General ophthalmologists refer those patients to us.

What steps should people take after age 50?

It depends on one’s history. Generally, I believe that all people with diabetes or a family history of macular degeneration, or their own history of macular degeneration, or anyone who experience flashes or floaters or shadows in vision should be seen by a retina specialist. Oftentimes, people get to us by referral from a general ophthalmologist or internist or optometrist, but it doesn’t need to be that way. Our services don’t need to require special referral. So if one is aware of these conditions, they can cut out the middle man.

Do some people ignore eye problems, or think they might be caused by other conditions that older people face?

Yes, but there are symptoms that oftentimes do 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.

Is there good news for any of the conditions you treat? What are some of the advances since you started practice?

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 and deliver better results than we’ve ever had before in terms of preservation of vision. 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.

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. These agents make abnormal blood vessels less permeable and are able to halt development of abnormal vasculature.

Talk about macular degeneration.

It’s a serious condition. It is the largest cause of visual loss in folks over 50 in the Western world. It’s an inherited disease. There are two broad types, the classic wet and dry. Dry macular degeneration is more common and, unfortunately, there is no treatment to date. It’s an area of intense research. Wet macular degeneration is less common but fortunately, if caught early enough, we do have treatment. Today, it’s mostly medical treatment, those injections that we talked about. Vision can be preserved but it is chronic and it takes repeated treatments.

Both wet and dry can be the source of significant visual loss. This is a chronic disease that doesn’t go away. It’s generally progressive.

What sort of research is going into dry macular degeneration?

There are many types of research. Pharmaceuticals are definitely being looked into and many think there may soon be some substances which may be effective. Stem cells have been looked into, retinal cell transplants. There hasn’t been a lot of success to date.

There is some genetic disposition toward Type 2 diabetes, but a lot of causes seem lifestyle-related. How can somebody with 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.

 If you’re going to have trouble with the eyes as a diabetic, is it almost always going to happen in the retinal area?

No. It can happen anywhere in the eye. Oftentimes, one can go for several years from the time of diagnosis without diabetic eye disease, but the incidence increases with the duration of disease. By seven years duration, roughly 50 percent of people will have some form of eye disease. By 20 years, 90 percent of people will have some form of eye disease.

How does diabetic eye disease progress and how is it treated?

A few things could happen with diabetes. Diabetes is a good example of many conditions that affect the retina in that it’s vascular in nature. Its effect on the eye is really an effect on blood vessels. The main problem in diabetes and diabetic eye disease is that blood vessels are abnormally leaky. One of the things that can happen is that fluid or blood can seep into the layers of the retina. That’s called macular edema and it’s one of the primary ways diabetes can lead to decreased vision. That is generally treated by injection therapy and also can be treated with laser photocoagulation.

Oftentimes, a combination of therapies is need to attack this kind of condition. The other big way that eyes can be affected is that they become ischemic, or devoid of good oxygen supply. When that happens, the eye in response will try to grow new blood vessels to try to help itself. It sounds like a great idea but in fact it’s not because the new blood vessels it tries to grow are more leaky than the original ones, so these are prone to large hemorrhages, which can really decrease vision. Diabetics can develop scaring and retinal detachments …

Diabetics also tend to form cataracts at younger ages than non-diabetics.

There are some diabetic patients who are very diligent and compliant with appointments and then for many others it’s a matter of education and letting them know how serious the condition can be. It’s a hard disease. It’s a hard disease that affects the organ systems, not just the eyes, so these patients have a lot of retina specialist appointments to go to but they are dealing with internists, endocrinologists, possibly nutritionists, podiatrists for foot ulcers, kidney specialists for renal failures.

What is it like to deal with patients losing their eyesight? How can you help them prepare for a loss of eyesight or potentially blindness?

That’s a hard question. For many, vision is poor when we first see them, or despite treatment for whatever condition they have, vision may not return. That is tough. We work closely with low vision and vision rehab centers. With folks who have significant visual loss, we try to get them help and get them involved with those centers so they can begin to develop adaptive techniques and receive training on devices that can help them to function in their daily activities.


Twitter: @BNrefresh

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