Macular Edema

Any folks in here have macular edema? Have you allowed laser treatment, and if
so, what kind of results have you had?

Also, since this is a motivated group, have any of you been the victims of
"early worsening" after getting your BG under control very quickly?

Syd

In article <5svgm29ft4us2q3jia48n5havag3ij3vdo@4ax.com>,
analog@logwell.com wrote:

> Any folks in here have macular edema? Have you allowed laser treatment, and
> if
> so, what kind of results have you had?
>
> Also, since this is a motivated group, have any of you been the victims of
> "early worsening" after getting your BG under control very quickly?
>

Go to google groups and search this newsgroup for postings by Chris J
(assuming you're talking about "early worsening" of ocular symptoms of
various sorts). Chris hasn't been around for a few months, but he did
have some scary symptoms a bit after getting his blood sugar under
control *very* quickly.

If Wendy pops in, she may have more to add, as she's part of the "eye
police".

--
AF
"Non Sequitur U has a really, really lousy debate team."
--artyw raises the bar on rec.sport.baseball

On Sat, 25 Nov 2006 17:40:38 +0000, analog wrote:

> Any folks in here have macular edema? Have you allowed laser treatment, and if
> so, what kind of results have you had?
>
> Also, since this is a motivated group, have any of you been the victims of
> "early worsening" after getting your BG under control very quickly?
>
> Syd

I don't know exactly what you're after, but I can relate my story. Last
year in the spring I noticed a rapid and profound change in my vision. I
had a focus range of about five feet to infinity for quite a number of
years (product of presbyopia as I'm 61 now). Suddenly I was able to read
the paper without glasses and distance vision was blurry. Called my doc
and he said to get an eye exam first - did that, all normal. Had a
physical exam shortly thereafter - followed by a rather urget call from
the doc to get my butt to his office asap. My BG was 300 and A1C was 11 -
he told me I was diabetic; put me on oral meds (metformin) and told me to
get exercise and change my diet - which I did. Immediately, my numbers
normalized. In a couple of weeks I found that my vision was shifting the
other way - I needed to stack reading glasses over my bifocals to read the
paper, and nothing was in focus without correction - I was using reading
glasses to be able to drive. A later discussion with the opthalmologist
explained that a rapid change is BG will affect the curvature of the lens
causing vision changes. I've not had any vision problems since then. At my
last exam the eye doc said if I was not diabetic he would not insist on
seeing me every year.

analog@logwell.com wrote: :

Any folks in here have macular edema? Have you allowed laser treatment,
and if : so, what kind of results have you had?

: Also, since this is a motivated group, have any of you been the victims of
: "early worsening" after getting your BG under control very quickly?

: Syd

I have wet macular edema and lost the central focus in my right eye some
8-9 years ago after a lasaring for wht the Opthamologist thought ws
diabetic edems. I won't let anyone touch my eyes wi high power lasr that
burns the eye.

I am currently, being treated with intraocular injections of Avastin, a
cancer med that shrinks the rapidly growing blood vessels and is beign
used off label. there is now, also Lucentis which is derived from teh
same molecuole as Avastin and is FDA approved. apparantly, the two drugs
work on different people so some a rare getting Avastin and some Lucentis
at my doactor's large paractice (13 macula, retina and vitreous
specialists).

Before the Avastin I had several PDT treatment involving a light
sensative chemical injected inot the blood stream and thena low level(cool
lasar) being shined into the eye for exactly 84 seconds, which activated
the chemical to shrink the rapidly growing blood vessels. This was
accompanied with a steroid injection intraocularly. this is a treatment
that hin general, has to be repeated fairly ofte, every few months of so,
depending on the individual. I resulted in some improvement, bu tnot very
long lasting fo rme.

The Avasstin, after an initial three monthly treatmet set lasted for over
10 months, during which time I had cataract surgery. The steroid shots
can accelerte the growth of catarcts. I had a new avasting shot last
month and will see the doctor early in December to see what is going on.
These new tretment are simply wonerful as I was afraid that I would loose
the central focus in the left eye and woudl be unable to read. M doctor
expects continuing progress. I, at the last test, was at 20/60 with
correction. Befor ethe cataract I was at 20/100! With my other eye I am
lucky to see the giant E if the card with it is held to the side so my
peripheral ivision can find it.

If you have dry macular edema, as fas as I know, there is no treatment,
but it is a much more gradual disease, not the sudden loss of sight that
comes with the wet form. I woke up one mornign and could not read the
newspaper! Fortunately, my regular retina specialist sent me to this
super specialist who actulally treats her 94 ear old father. It has been
my salvation. I may use a magnifier to make reading easaier adn I read
the newspaper on the web, as I can enlarge the print somewhat, to make it
easier, but I am bact to reading some of thepaper at breakfast without the
magnifier, as it is difficult to eat and drink while holding a glass in
your right hand:-) I can do it, bu tit is more restful to use the glass
or the 2x magnifier drugstore glasses I currntly have. some of this is
related to the change in correction after the cataract which makes me
considerably less myopic so newsprint is much smaller looking htt it used
to be.

I hope this is of some help to you.

If you want more information, just email me.

The second part of your letter is unclear. do yu mean vision problems
after a rapid drop in BG or a rise in Bg after a rapid start. Can't help
wiwth either of these.

Wendy

On Sat, 25 Nov 2006 20:03:12 +0000 (UTC), "W. Baker"
<wbaker@panix.com> wrote:
>
>I have wet macular edema and lost the central focus in my right eye some
>8-9 years ago after a lasering for what the Opthamologist thought was
>diabetic edema. I won't let anyone touch my eyes with high power laser that
>burns the eye.
>
Well, it's true that laser treatment around the macula can get pretty
dicey. But this has to be distinguished from pan-retinal (peripheral)
photocoagulation, which is the treatment of choice for diabetic
retinopathy. I had the full course of laser treatment some 20 years
ago (about 2,000 burns in each eye), and, basically, it saved my
sight. The retinopathy hasn't progressed these 20 years, and I've been
spared from the need for worse procedures, such as vitrectomy.

What I am after is a handle on other people's experience with the so called
early-worsening syndrome. I very rapidly got my BG under control, and was
rewarded with mild diabetic retinopathy (macular edema) after my A1C was in the
normal range. It had been high for probably years, but the eye problems only
showed up after the rapid reduction in BG levels. I have been curious ever
since if the early worsening is a fiction, or if something is really going on
there. Some have even suggested that T2 patients should be cautioned not to
lower chronically high BG too fast (I did it really fast with Metformin and a
low carb diet a few years back).

The other thing I am curious about is people's experience with laser coagulation
for macular edema. I have refused it to date, and have been lucky that my
macular edema seems to have somewhat stabilized. But when most doctors advise
to do it, one gets nervous being a contrarian. I had not heard of the laser
treatment leading to wet macular disease. That is spooky!

Syd

On Sat, 25 Nov 2006 13:53:02 -0700, ray <ray@zianet.com> wrote:

>On Sat, 25 Nov 2006 17:40:38 +0000, analog wrote:
>
>> Any folks in here have macular edema? Have you allowed laser treatment, and if
>> so, what kind of results have you had?
>>
>> Also, since this is a motivated group, have any of you been the victims of
>> "early worsening" after getting your BG under control very quickly?
>>
>> Syd
>
>I don't know exactly what you're after, but I can relate my story. Last
>year in the spring I noticed a rapid and profound change in my vision. I
>had a focus range of about five feet to infinity for quite a number of
>years (product of presbyopia as I'm 61 now). Suddenly I was able to read
>the paper without glasses and distance vision was blurry. Called my doc
>and he said to get an eye exam first - did that, all normal. Had a
>physical exam shortly thereafter - followed by a rather urget call from
>the doc to get my butt to his office asap. My BG was 300 and A1C was 11 -
>he told me I was diabetic; put me on oral meds (metformin) and told me to
>get exercise and change my diet - which I did. Immediately, my numbers
>normalized. In a couple of weeks I found that my vision was shifting the
>other way - I needed to stack reading glasses over my bifocals to read the
>paper, and nothing was in focus without correction - I was using reading
>glasses to be able to drive. A later discussion with the opthalmologist
>explained that a rapid change is BG will affect the curvature of the lens
>causing vision changes. I've not had any vision problems since then. At my
>last exam the eye doc said if I was not diabetic he would not insist on
>seeing me every year.

analog@logwell.com wrote: : What I am after is a handle on other people's
experience with the so called : early-worsening syndrome. I very rapidly
got my BG under control, and was : rewarded with mild diabetic retinopathy
(macular edema) after my A1C was in the : normal range.

this is a known problem, but regarded as very rare. ChrisJ had this
problem after he droppe dextremely rapidly, being on insulin and eating
nothing but tofu an dsteamed vegetables and gettign off the insulin in 6
days!. He had been diagnosed because of a nasty infection tht would not
heal. His damage seems to have been on the sid eof his eye, not in the
macula, so lasar worked for him. I spoke to my doctor about this and
about the information that we, as amateurs shuld give to newly diagnosed
diabetic who scome here. His advice waa that the importanc eof gettin g
blood sugars down is so great that we shoudl not give peole a reason not
to pursure it aggressively, as the condition is so rare. Yu ae the
second case we have heard aabout on this group. Several of us, who hav
ehad vision problems ancall ourselves the :eye police: and advize all
newbies to see an opthamologist ASAP after diagnosis for a fully dilated
retinal exam, bu not putting in a wrning about too fast a drop in the
bolld sugars, as this is usually not th eproblem, but too slow is. We
tell them no to wait until their viaion has stabilized as they can always
go for new glasses later.


It had been high
for probably years, but the eye problems only : showed up after the rapid
reduction in BG levels. I have been curious ever : since if the early
worsening is a fiction, or if something is really going on : there. Some
have even suggested that T2 patients should be cautioned not to : lower
chronically high BG too fast (I did it really fast with Metformin and a :
low carb diet a few years back).

Did you have the macular problem right after lowering the carbs as was the
cse with ChrisJ, or is it just occurring now, some years laer? If it is
just occurring now, first make sure that it is diabetic and then inquire
aobu tthe poeeibilit of the steroid treatment. It may hasten
cataracts,but that is a fairly routinne proceedure now. If you are having
the edema now, tell the doctor to make suere it is diabeic in origin and
not wet macular degeneration.


: The other thing I am curious about is people's experience with laser
coagulation : for macular edema. I have refused it to date, and have been
lucky that my : macular edema seems to have somewhat stabilized. But when
most doctors advise : to do it, one gets nervous being a contrarian. I
had not heard of the laser : treatment leading to wet macular disease.
That is spooky!

It does not lead to wet macular degeneration bu tthey can be mistaken fo
reach other and the treatment protocols are wuite different at this time,
bu tyou may well have to go to a retinal pratice for the latest help.

Wendy

On Sat, 25 Nov 2006 20:56:31 +0000, analog wrote:

> What I am after is a handle on other people's experience with the so called
> early-worsening syndrome. I very rapidly got my BG under control, and was
> rewarded with mild diabetic retinopathy (macular edema) after my A1C was in the
> normal range. It had been high for probably years, but the eye problems only
> showed up after the rapid reduction in BG levels. I have been curious ever
> since if the early worsening is a fiction, or if something is really going on
> there. Some have even suggested that T2 patients should be cautioned not to
> lower chronically high BG too fast (I did it really fast with Metformin and a
> low carb diet a few years back).
>

My BG normalized very quickly too. It took about three weeks for my vision
to return to normal - since then, no problem.


> The other thing I am curious about is people's experience with laser coagulation
> for macular edema. I have refused it to date, and have been lucky that my
> macular edema seems to have somewhat stabilized. But when most doctors advise
> to do it, one gets nervous being a contrarian. I had not heard of the laser
> treatment leading to wet macular disease. That is spooky!
>
> Syd
>
> On Sat, 25 Nov 2006 13:53:02 -0700, ray <ray@zianet.com> wrote:
>
>>On Sat, 25 Nov 2006 17:40:38 +0000, analog wrote:
>>
>>> Any folks in here have macular edema? Have you allowed laser treatment, and if
>>> so, what kind of results have you had?
>>>
>>> Also, since this is a motivated group, have any of you been the victims of
>>> "early worsening" after getting your BG under control very quickly?
>>>
>>> Syd
>>
>>I don't know exactly what you're after, but I can relate my story. Last
>>year in the spring I noticed a rapid and profound change in my vision. I
>>had a focus range of about five feet to infinity for quite a number of
>>years (product of presbyopia as I'm 61 now). Suddenly I was able to read
>>the paper without glasses and distance vision was blurry. Called my doc
>>and he said to get an eye exam first - did that, all normal. Had a
>>physical exam shortly thereafter - followed by a rather urget call from
>>the doc to get my butt to his office asap. My BG was 300 and A1C was 11 -
>>he told me I was diabetic; put me on oral meds (metformin) and told me to
>>get exercise and change my diet - which I did. Immediately, my numbers
>>normalized. In a couple of weeks I found that my vision was shifting the
>>other way - I needed to stack reading glasses over my bifocals to read the
>>paper, and nothing was in focus without correction - I was using reading
>>glasses to be able to drive. A later discussion with the opthalmologist
>>explained that a rapid change is BG will affect the curvature of the lens
>>causing vision changes. I've not had any vision problems since then. At my
>>last exam the eye doc said if I was not diabetic he would not insist on
>>seeing me every year.

My experience was a few years ago and immediately followed a very rapid
reduction in BG. I had gone to the ophthalmologist right after being diagnosed
as diabetic and was given a clean bill of health (no sign of retinopathy). A
couple of weeks later I noticed distortion of straight lines and some distortion
in the right eye only. I was advised by the local retina specialist as well as
a professor at Johns Hopkins to immediately have focused laser photocoagulation,
but declined the treatment. It is now several years later, and the condition is
relatively stable, but has not gone away. Based on my experience, I would
advise any newly diagnosed diabetic to exercise some restraint in lowering BG
too fast. Several A1C points in 30 days may be too fast.


On Sat, 25 Nov 2006 21:56:50 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

>analog@logwell.com wrote: : What I am after is a handle on other people's
>experience with the so called : early-worsening syndrome. I very rapidly
>got my BG under control, and was : rewarded with mild diabetic retinopathy
>(macular edema) after my A1C was in the : normal range.
>
>this is a known problem, but regarded as very rare. ChrisJ had this
>problem after he droppe dextremely rapidly, being on insulin and eating
>nothing but tofu an dsteamed vegetables and gettign off the insulin in 6
>days!. He had been diagnosed because of a nasty infection tht would not
>heal. His damage seems to have been on the sid eof his eye, not in the
>macula, so lasar worked for him. I spoke to my doctor about this and
>about the information that we, as amateurs shuld give to newly diagnosed
>diabetic who scome here. His advice waa that the importanc eof gettin g
>blood sugars down is so great that we shoudl not give peole a reason not
>to pursure it aggressively, as the condition is so rare. Yu ae the
>second case we have heard aabout on this group. Several of us, who hav
>ehad vision problems ancall ourselves the :eye police: and advize all
>newbies to see an opthamologist ASAP after diagnosis for a fully dilated
>retinal exam, bu not putting in a wrning about too fast a drop in the
>bolld sugars, as this is usually not th eproblem, but too slow is. We
>tell them no to wait until their viaion has stabilized as they can always
>go for new glasses later.
>
>
> It had been high
>for probably years, but the eye problems only : showed up after the rapid
>reduction in BG levels. I have been curious ever : since if the early
>worsening is a fiction, or if something is really going on : there. Some
>have even suggested that T2 patients should be cautioned not to : lower
>chronically high BG too fast (I did it really fast with Metformin and a :
>low carb diet a few years back).
>
>Did you have the macular problem right after lowering the carbs as was the
>cse with ChrisJ, or is it just occurring now, some years laer? If it is
>just occurring now, first make sure that it is diabetic and then inquire
>aobu tthe poeeibilit of the steroid treatment. It may hasten
>cataracts,but that is a fairly routinne proceedure now. If you are having
>the edema now, tell the doctor to make suere it is diabeic in origin and
>not wet macular degeneration.
>
>
>: The other thing I am curious about is people's experience with laser
>coagulation : for macular edema. I have refused it to date, and have been
>lucky that my : macular edema seems to have somewhat stabilized. But when
>most doctors advise : to do it, one gets nervous being a contrarian. I
>had not heard of the laser : treatment leading to wet macular disease.
>That is spooky!
>
>It does not lead to wet macular degeneration bu tthey can be mistaken fo
>reach other and the treatment protocols are wuite different at this time,
>bu tyou may well have to go to a retinal pratice for the latest help.
>
>Wendy

analog@logwell.com wrote:
: My experience was a few years ago and immediately followed a very rapid
: reduction in BG. I had gone to the ophthalmologist right after being diagnosed
: as diabetic and was given a clean bill of health (no sign of retinopathy). A
: couple of weeks later I noticed distortion of straight lines and some distortion
: in the right eye only. I was advised by the local retina specialist as well as
: a professor at Johns Hopkins to immediately have focused laser photocoagulation,
: but declined the treatment. It is now several years later, and the condition is
: relatively stable, but has not gone away. Based on my experience, I would
: advise any newly diagnosed diabetic to exercise some restraint in lowering BG
: too fast. Several A1C points in 30 days may be too fast.

Wow! that is fast, and quite like Chris J, the other case I talked
about. You do seem to be in good hands, given the Hopkins reference. I
woudl suggest you look into the possibilityof a steroid injection, which
might give some improvement. I do not know if it is something tht has to
be repeated or not. There are great changes constantly, in the field, so
steriod may not have been available at the timem of your diagnoses.
ChrisJ did have soem lasar, after investigating the steroid option, but he
was told it was to the side of the (I am not sure) of th macula or eye
and steroid would be the proceedure for more central damage.

Wendy

In message <afaber-378FC1.12540225112006@reader2.panix.com>, Alice Faber
<afaber@panix.com> writes
>In article <5svgm29ft4us2q3jia48n5havag3ij3vdo@4ax.com>,
> analog@logwell.com wrote:
>
>> Any folks in here have macular edema? Have you allowed laser treatment, and
>> if
>> so, what kind of results have you had?
>>
>> Also, since this is a motivated group, have any of you been the victims of
>> "early worsening" after getting your BG under control very quickly?
>>
>
>Go to google groups and search this newsgroup for postings by Chris J
>(assuming you're talking about "early worsening" of ocular symptoms of
>various sorts). Chris hasn't been around for a few months, but he did
>have some scary symptoms a bit after getting his blood sugar under
>control *very* quickly.
>
>If Wendy pops in, she may have more to add, as she's part of the "eye
>police".
Another Chris here. I suffered retinopathy as a result of getting my BG
under control rather too rapidly (according to my eye specialist).
I actually observed on a day to day basis my vision changing which was
very spooky indeed.
I needed minor laser treatment to both eyes - only about a dozen shots
each side - but my specialist said that as there was macular edema in
the right hand side he 'wouldn't go there'.
I also had a cataract in that eye (how I was diagnosed with diabetes in
the first place) which the team were loathe to treat until it got to the
stage where they couldn't see past it to the retina.
This stage was reached in the summer and, in August, I had the cataract
removed and, despite warnings not to expect wonderful results (because
of the damage already done), it was wonderful - a few missing pixels,
but, wow!
Now waiting for the other side cataract to be done to balance up my
colours.
--
Chris Booth T2

I refused the focal laser treatments, and it turned out to be a good call. I
philosophically do not like ablative treatments; and I have heard of many cases
where the cure was worse than the disease. If I get worse, I will consider
either injections or systemic steroid treatment (with careful BG management).
Incidentally, I experimented with steroid eye drops a couple of years back, but
predictably saw little if any benefit. I am not sure if i could stand
injections directly into the eye! I am not a very good patient when it comes to
needles...


On Sun, 26 Nov 2006 17:45:25 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

>analog@logwell.com wrote:
>: My experience was a few years ago and immediately followed a very rapid
>: reduction in BG. I had gone to the ophthalmologist right after being diagnosed
>: as diabetic and was given a clean bill of health (no sign of retinopathy). A
>: couple of weeks later I noticed distortion of straight lines and some distortion
>: in the right eye only. I was advised by the local retina specialist as well as
>: a professor at Johns Hopkins to immediately have focused laser photocoagulation,
>: but declined the treatment. It is now several years later, and the condition is
>: relatively stable, but has not gone away. Based on my experience, I would
>: advise any newly diagnosed diabetic to exercise some restraint in lowering BG
>: too fast. Several A1C points in 30 days may be too fast.
>
>Wow! that is fast, and quite like Chris J, the other case I talked
>about. You do seem to be in good hands, given the Hopkins reference. I
>woudl suggest you look into the possibilityof a steroid injection, which
>might give some improvement. I do not know if it is something tht has to
>be repeated or not. There are great changes constantly, in the field, so
>steriod may not have been available at the timem of your diagnoses.
>ChrisJ did have soem lasar, after investigating the steroid option, but he
>was told it was to the side of the (I am not sure) of th macula or eye
>and steroid would be the proceedure for more central damage.
>
>Wendy

analog@logwell.com wrote:
: I refused the focal laser treatments, and it turned out to be a good call. I
: philosophically do not like ablative treatments; and I have heard of many cases
: where the cure was worse than the disease. If I get worse, I will consider
: either injections or systemic steroid treatment (with careful BG management).
: Incidentally, I experimented with steroid eye drops a couple of years back, but
: predictably saw little if any benefit. I am not sure if i could stand
: injections directly into the eye! I am not a very good patient when it comes to
: needles...

I also found the idea rther gross, but they use an anesthetic in the eye
and it feels uncomfortable, but not painful. One thing to know, as Iwas
not wrned. When I had the first steroid shotI opened my eye and saw only
black, nothing at all! I ws being asked if ai could see fingers, etc andI
let out a yell likeI have never yelled before. It seems that the pressure
inthe eye went very high, resultin gin some seconds of totalblack. The
doctor ws getting ready to release some fluid from my eye when I becgan to
see first it looked like a window on a cold rainy day with steam on it and
a few trickles of clear and then rapidly cleared. When I asked why this
possibility had not been discussed with me they said it was very rare.
I said you told me there is a one in 1000 chance of infection, is this
less common than that and they said no, so I now warn people about this
scary short-lived possibility. The Avastin does not do this because the
volume of the drug is considerably less. Go for the injection as it works
directly where needed and don't try systemic steroid which, I imagine,
would be less affective and woudl wreak havoc with your bg control
unnecessarily. I never thught I woudl put up with all this stuff, but
when you need to, you just grit our teeth and do it.

Wendy

Chris Booth wrote:

> Another Chris here. I suffered retinopathy as a result of
getting my
> BG under control rather too rapidly (according to my eye
specialist).

Were you on insulin?

Yeah, you can learn to endure what you must. I recently started Byetta, and
would have bet you money a few weeks back I would never self inject until the
day I absolutely had to (as in the oral T2 meds no longer working). But here I
am happy as a clam injecting lizard spit twice a day...

Systemic steroids are indeed problematic with respect to BG control, but with
careful medication monitoring, good results have been had. Dr. Hayreh was kind
enough to correspond with me directly by email a couple of years back. He
essentially agrees with my objections to both pan retinal and focal laser
photocoagiulation as destructive procedures with a considerable downside. He
has had a good deal of success with systemic steroid treatment of macular
problems, some incredibly dramatic. Now the question is does the risk of
injection of steroids or other agents directly into the eye outweigh the extra
caution necessary to maintain BG control in diabetic patients undergoing
systemic steroid therapy?

I have a nagging concern here that profitability enters into the equation with
most ophthalmologists. They do not stand to make much off systemic steroid
treatment, and are faced with coordinating with the internist / endocrinologist
concerning BG control. But a quick laser blast is worth a few thousand bucks,
and I fear the injected steroids may be getting similar consideration. It is
telling they did not do an adequate job of giving you adequate information for
truly informed consent.



On Sun, 26 Nov 2006 20:23:34 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

>analog@logwell.com wrote:
>: I refused the focal laser treatments, and it turned out to be a good call. I
>: philosophically do not like ablative treatments; and I have heard of many cases
>: where the cure was worse than the disease. If I get worse, I will consider
>: either injections or systemic steroid treatment (with careful BG management).
>: Incidentally, I experimented with steroid eye drops a couple of years back, but
>: predictably saw little if any benefit. I am not sure if i could stand
>: injections directly into the eye! I am not a very good patient when it comes to
>: needles...
>
>I also found the idea rther gross, but they use an anesthetic in the eye
>and it feels uncomfortable, but not painful. One thing to know, as Iwas
>not wrned. When I had the first steroid shotI opened my eye and saw only
>black, nothing at all! I ws being asked if ai could see fingers, etc andI
>let out a yell likeI have never yelled before. It seems that the pressure
>inthe eye went very high, resultin gin some seconds of totalblack. The
>doctor ws getting ready to release some fluid from my eye when I becgan to
>see first it looked like a window on a cold rainy day with steam on it and
>a few trickles of clear and then rapidly cleared. When I asked why this
>possibility had not been discussed with me they said it was very rare.
>I said you told me there is a one in 1000 chance of infection, is this
>less common than that and they said no, so I now warn people about this
>scary short-lived possibility. The Avastin does not do this because the
>volume of the drug is considerably less. Go for the injection as it works
>directly where needed and don't try systemic steroid which, I imagine,
>would be less affective and woudl wreak havoc with your bg control
>unnecessarily. I never thught I woudl put up with all this stuff, but
>when you need to, you just grit our teeth and do it.
>
>Wendy
>

analog@logwell.com wrote:
: Yeah, you can learn to endure what you must. I recently started Byetta, and
: would have bet you money a few weeks back I would never self inject until the
: day I absolutely had to (as in the oral T2 meds no longer working). But here I
: am happy as a clam injecting lizard spit twice a day...

: Systemic steroids are indeed problematic with respect to BG control, but with
: careful medication monitoring, good results have been had. Dr. Hayreh was kind
: enough to correspond with me directly by email a couple of years back. He
: essentially agrees with my objections to both pan retinal and focal laser
: photocoagiulation as destructive procedures with a considerable downside. He
: has had a good deal of success with systemic steroid treatment of macular
: problems, some incredibly dramatic. Now the question is does the risk of
: injection of steroids or other agents directly into the eye outweigh the extra
: caution necessary to maintain BG control in diabetic patients undergoing
: systemic steroid therapy?

: I have a nagging concern here that profitability enters into the equation with
: most ophthalmologists. They do not stand to make much off systemic steroid
: treatment, and are faced with coordinating with the internist / endocrinologist
: concerning BG control. But a quick laser blast is worth a few thousand bucks,
: and I fear the injected steroids may be getting similar consideration. It is
: telling they did not do an adequate job of giving you adequate information for
: truly informed consent.



: On Sun, 26 Nov 2006 20:23:34 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

: >analog@logwell.com wrote:
: >: I refused the focal laser treatments, and it turned out to be a good call. I
: >: philosophically do not like ablative treatments; and I have heard of many cases
: >: where the cure was worse than the disease. If I get worse, I will consider
: >: either injections or systemic steroid treatment (with careful BG management).
: >: Incidentally, I experimented with steroid eye drops a couple of years back, but
: >: predictably saw little if any benefit. I am not sure if i could stand
: >: injections directly into the eye! I am not a very good patient when it comes to
: >: needles...
: >
: >I also found the idea rther gross, but they use an anesthetic in the eye
: >and it feels uncomfortable, but not painful. One thing to know, as Iwas
: >not wrned. When I had the first steroid shotI opened my eye and saw only
: >black, nothing at all! I ws being asked if ai could see fingers, etc andI
: >let out a yell likeI have never yelled before. It seems that the pressure
: >inthe eye went very high, resultin gin some seconds of totalblack. The
: >doctor ws getting ready to release some fluid from my eye when I becgan to
: >see first it looked like a window on a cold rainy day with steam on it and
: >a few trickles of clear and then rapidly cleared. When I asked why this
: >possibility had not been discussed with me they said it was very rare.
: >I said you told me there is a one in 1000 chance of infection, is this
: >less common than that and they said no, so I now warn people about this
: >scary short-lived possibility. The Avastin does not do this because the
: >volume of the drug is considerably less. Go for the injection as it works
: >directly where needed and don't try systemic steroid which, I imagine,
: >would be less affective and woudl wreak havoc with your bg control
: >unnecessarily. I never thught I woudl put up with all this stuff, but
: >when you need to, you just grit our teeth and do it.
: >
: >Wendy
: >

In message <12mk2343006s118@news.supernews.com>, Ozgirl
<are_we_there_yet@maccas.com> writes
>Chris Booth wrote:
>
>> Another Chris here. I suffered retinopathy as a result of
>getting my
>> BG under control rather too rapidly (according to my eye
>specialist).
>
>Were you on insulin?

No - I started off on diet and exercise, but that didn't work, so I went
onto glyclazide - the Modified Release version - which did the trick
..... rather too well at the time. I went from an HbA1C of nearly 11 to
5.9 in six months.

--
Chris Booth

Chris Booth <chrisbooth@froyle.com> wrote:
: In message <12mk2343006s118@news.supernews.com>, Ozgirl
: <are_we_there_yet@maccas.com> writes
: >Chris Booth wrote:
: >
: >> Another Chris here. I suffered retinopathy as a result of
: >getting my
: >> BG under control rather too rapidly (according to my eye
: >specialist).
: >
: >Were you on insulin?

: No - I started off on diet and exercise, but that didn't work, so I went
: onto glyclazide - the Modified Release version - which did the trick
: .... rather too well at the time. I went from an HbA1C of nearly 11 to
: 5.9 in six months.

: --
: Chris Booth

That is very interesting, as we have many who manage that kind of drop in
6 months with no vision problem other than temporary blurring which
dissapaes as bgs level off. ChrisJ dropped from over 500 at diagnosis to
someplace in the low 100's as far as I recalll, in a few days.
Interestingly, considering all the flack around here regarding people who
advocate "low carbs" we all were urging him to eat come carbs and not
just live on tofu and spinach.

Wendy

W. Baker wrote:
> Chris Booth <chrisbooth@froyle.com> wrote:
>: In message <12mk2343006s118@news.supernews.com>, Ozgirl
>: <are_we_there_yet@maccas.com> writes
>: >Chris Booth wrote:
>: >
>: >> Another Chris here. I suffered retinopathy as a result
of
>: >getting my
>: >> BG under control rather too rapidly (according to my
eye
>: >> specialist).
>: >
>: >Were you on insulin?
>
>: No - I started off on diet and exercise, but that didn't
work, so I
>: went onto glyclazide - the Modified Release version -
which did the
>: trick .... rather too well at the time. I went from an
HbA1C of
>: nearly 11 to
>: 5.9 in six months.
>
>: --
>: Chris Booth
>
> That is very interesting, as we have many who manage that
kind of
> drop in 6 months with no vision problem other than
temporary blurring
> which dissapaes as bgs level off. ChrisJ dropped from
over 500 at
> diagnosis to someplace in the low 100's as far as I
recalll, in a few
> days. Interestingly, considering all the flack around here
regarding
> people who advocate "low carbs" we all were urging him to
eat come
> carbs and not just live on tofu and spinach.
>
> Wendy

I was interested to know about the insulin because I have
only seen reports from ophthalmologists about that effect
when the control was gained fast with insulin not oral meds
or strict dieting. I think it was the DCCT trials that had
the most to say about that phenomenon.

Chris, did you have baseline eye tests to compare with? i.e.
did you have your eyes tested right before or at the
beginning of your diabetes treatment? My ex went from a 12.4
A1c to 5.8 in weeks with diet and Metformin. A reduction of
your size over 6 months isn't particularly fast, many people
have a good A1c result once treatment starts.

In message <12mmnon3boia430@news.supernews.com>, Ozgirl
<are_we_there_yet@maccas.com> writes
>W. Baker wrote:
>> Chris Booth <chrisbooth@froyle.com> wrote:
>>: In message <12mk2343006s118@news.supernews.com>, Ozgirl
>>: <are_we_there_yet@maccas.com> writes
>>: >Chris Booth wrote:
>>: >
>>: >> Another Chris here. I suffered retinopathy as a result
>of
>>: >getting my
>>: >> BG under control rather too rapidly (according to my
>eye
>>: >> specialist).
>>: >
>>: >Were you on insulin?
>>
>>: No - I started off on diet and exercise, but that didn't
>work, so I
>>: went onto glyclazide - the Modified Release version -
>which did the
>>: trick .... rather too well at the time. I went from an
>HbA1C of
>>: nearly 11 to
>>: 5.9 in six months.
>>
>>: --
>>: Chris Booth
>>
>> That is very interesting, as we have many who manage that
>kind of
>> drop in 6 months with no vision problem other than
>temporary blurring
>> which dissapaes as bgs level off. ChrisJ dropped from
>over 500 at
>> diagnosis to someplace in the low 100's as far as I
>recalll, in a few
>> days. Interestingly, considering all the flack around here
>regarding
>> people who advocate "low carbs" we all were urging him to
>eat come
>> carbs and not just live on tofu and spinach.
>>
>> Wendy
>
>I was interested to know about the insulin because I have
>only seen reports from ophthalmologists about that effect
>when the control was gained fast with insulin not oral meds
>or strict dieting. I think it was the DCCT trials that had
>the most to say about that phenomenon.
>
>Chris, did you have baseline eye tests to compare with? i.e.
>did you have your eyes tested right before or at the
>beginning of your diabetes treatment? My ex went from a 12.4
>A1c to 5.8 in weeks with diet and Metformin. A reduction of
>your size over 6 months isn't particularly fast, many people
>have a good A1c result once treatment starts.
>
My optometrist sent me to my doctor in April (03) having found the
cataract during a thorough eye exam.
I stayed on D and E until August - this had only bought me down to an
HbA1C of 10. In August I started meds (the Glyclazide) which had pulled
me down to 5.9 around November (still 03).
My optometrist was unhappy at a check in November and I was then passed
on to my current specialist team. They found retinopathy, but not enough
to warrant laser treatment until the next year.

Hope this makes sense.
--
Chris Booth

Chris Booth <chrisbooth@froyle.com> wrote:
: In message <12mmnon3boia430@news.supernews.com>, Ozgirl
: <are_we_there_yet@maccas.com> writes
: >W. Baker wrote:
: >> Chris Booth <chrisbooth@froyle.com> wrote:
: >>: In message <12mk2343006s118@news.supernews.com>, Ozgirl
: >>: <are_we_there_yet@maccas.com> writes
: >>: >Chris Booth wrote:
: >>: >
: >>: >> Another Chris here. I suffered retinopathy as a result
: >of
: >>: >getting my
: >>: >> BG under control rather too rapidly (according to my
: >eye
: >>: >> specialist).
: >>: >
: >>: >Were you on insulin?
: >>
: >>: No - I started off on diet and exercise, but that didn't
: >work, so I
: >>: went onto glyclazide - the Modified Release version -
: >which did the
: >>: trick .... rather too well at the time. I went from an
: >HbA1C of
: >>: nearly 11 to
: >>: 5.9 in six months.
: >>
: >>: --
: >>: Chris Booth
: >>
: >> That is very interesting, as we have many who manage that
: >kind of
: >> drop in 6 months with no vision problem other than
: >temporary blurring
: >> which dissapaes as bgs level off. ChrisJ dropped from
: >over 500 at
: >> diagnosis to someplace in the low 100's as far as I
: >recalll, in a few
: >> days. Interestingly, considering all the flack around here
: >regarding
: >> people who advocate "low carbs" we all were urging him to
: >eat come
: >> carbs and not just live on tofu and spinach.
: >>
: >> Wendy
: >
: >I was interested to know about the insulin because I have
: >only seen reports from ophthalmologists about that effect
: >when the control was gained fast with insulin not oral meds
: >or strict dieting. I think it was the DCCT trials that had
: >the most to say about that phenomenon.
: >
: >Chris, did you have baseline eye tests to compare with? i.e.
: >did you have your eyes tested right before or at the
: >beginning of your diabetes treatment? My ex went from a 12.4
: >A1c to 5.8 in weeks with diet and Metformin. A reduction of
: >your size over 6 months isn't particularly fast, many people
: >have a good A1c result once treatment starts.
: >
: My optometrist sent me to my doctor in April (03) having found the
: cataract during a thorough eye exam.
: I stayed on D and E until August - this had only bought me down to an
: HbA1C of 10. In August I started meds (the Glyclazide) which had pulled
: me down to 5.9 around November (still 03).
: My optometrist was unhappy at a check in November and I was then passed
: on to my current specialist team. They found retinopathy, but not enough
: to warrant laser treatment until the next year.

: Hope this makes sense.
: --
: Chris Booth

It makes sense, but I don't see it as a result of rapid bg reduction, just
a very unfortunate result of undiagnosed diabetes tht developed over time
(years before your diagnosis).

Wendy

My BG normalization was much, much quicker. And I had a baseline retinal exam
with no retinopathy apparent just before the dramatic BG change. Almost
overnight I developed clinically significant macular edema. However, I still
remain skeptical there really is such a thing as early worsening. Nevertheless,
my experience is a bit difficult to explain. Incidentally, I self-diagnosed
macular edema from the symptoms. In bright sunlight, I could actually see light
spots that were later obviously in the very pattern of the inflammation evident
on the retinal pics.


On Tue, 28 Nov 2006 14:59:50 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

>Chris Booth <chrisbooth@froyle.com> wrote:
>: In message <12mmnon3boia430@news.supernews.com>, Ozgirl
>: <are_we_there_yet@maccas.com> writes
>: >W. Baker wrote:
>: >> Chris Booth <chrisbooth@froyle.com> wrote:
>: >>: In message <12mk2343006s118@news.supernews.com>, Ozgirl
>: >>: <are_we_there_yet@maccas.com> writes
>: >>: >Chris Booth wrote:
>: >>: >
>: >>: >> Another Chris here. I suffered retinopathy as a result
>: >of
>: >>: >getting my
>: >>: >> BG under control rather too rapidly (according to my
>: >eye
>: >>: >> specialist).
>: >>: >
>: >>: >Were you on insulin?
>: >>
>: >>: No - I started off on diet and exercise, but that didn't
>: >work, so I
>: >>: went onto glyclazide - the Modified Release version -
>: >which did the
>: >>: trick .... rather too well at the time. I went from an
>: >HbA1C of
>: >>: nearly 11 to
>: >>: 5.9 in six months.
>: >>
>: >>: --
>: >>: Chris Booth
>: >>
>: >> That is very interesting, as we have many who manage that
>: >kind of
>: >> drop in 6 months with no vision problem other than
>: >temporary blurring
>: >> which dissapaes as bgs level off. ChrisJ dropped from
>: >over 500 at
>: >> diagnosis to someplace in the low 100's as far as I
>: >recalll, in a few
>: >> days. Interestingly, considering all the flack around here
>: >regarding
>: >> people who advocate "low carbs" we all were urging him to
>: >eat come
>: >> carbs and not just live on tofu and spinach.
>: >>
>: >> Wendy
>: >
>: >I was interested to know about the insulin because I have
>: >only seen reports from ophthalmologists about that effect
>: >when the control was gained fast with insulin not oral meds
>: >or strict dieting. I think it was the DCCT trials that had
>: >the most to say about that phenomenon.
>: >
>: >Chris, did you have baseline eye tests to compare with? i.e.
>: >did you have your eyes tested right before or at the
>: >beginning of your diabetes treatment? My ex went from a 12.4
>: >A1c to 5.8 in weeks with diet and Metformin. A reduction of
>: >your size over 6 months isn't particularly fast, many people
>: >have a good A1c result once treatment starts.
>: >
>: My optometrist sent me to my doctor in April (03) having found the
>: cataract during a thorough eye exam.
>: I stayed on D and E until August - this had only bought me down to an
>: HbA1C of 10. In August I started meds (the Glyclazide) which had pulled
>: me down to 5.9 around November (still 03).
>: My optometrist was unhappy at a check in November and I was then passed
>: on to my current specialist team. They found retinopathy, but not enough
>: to warrant laser treatment until the next year.
>
>: Hope this makes sense.
>: --
>: Chris Booth
>
>It makes sense, but I don't see it as a result of rapid bg reduction, just
>a very unfortunate result of undiagnosed diabetes tht developed over time
>(years before your diagnosis).
>
>Wendy

I forgot to mention it, but I was singularly unimpressed with the big shot
female professor I saw at Johns Hopkins. I finally wound up with a very nice
female doctor out of Barnes-Jewish in St. Louis. She was the first doctor to
suggest I acted wisely in refusing the focal laser treatments given my
determination to maintain decent BG control. I have come to regard the
over-eagerness to perform focal laser coagulation much the same way I look at
PCI (angiograms and stenting) in cardiology. More profit driven than anything
else.

On Sun, 26 Nov 2006 17:45:25 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:

>analog@logwell.com wrote:
>: My experience was a few years ago and immediately followed a very rapid
>: reduction in BG. I had gone to the ophthalmologist right after being diagnosed
>: as diabetic and was given a clean bill of health (no sign of retinopathy). A
>: couple of weeks later I noticed distortion of straight lines and some distortion
>: in the right eye only. I was advised by the local retina specialist as well as
>: a professor at Johns Hopkins to immediately have focused laser photocoagulation,
>: but declined the treatment. It is now several years later, and the condition is
>: relatively stable, but has not gone away. Based on my experience, I would
>: advise any newly diagnosed diabetic to exercise some restraint in lowering BG
>: too fast. Several A1C points in 30 days may be too fast.
>
>Wow! that is fast, and quite like Chris J, the other case I talked
>about. You do seem to be in good hands, given the Hopkins reference. I
>woudl suggest you look into the possibilityof a steroid injection, which
>might give some improvement. I do not know if it is something tht has to
>be repeated or not. There are great changes constantly, in the field, so
>steriod may not have been available at the timem of your diagnoses.
>ChrisJ did have soem lasar, after investigating the steroid option, but he
>was told it was to the side of the (I am not sure) of th macula or eye
>and steroid would be the proceedure for more central damage.
>
>Wendy

I had the intraocular steroid shots rather than the laser surgery
because the retinopathy was too close to the macula. I had been
advised to have laser surgery, but sought a second opinion which was
wait and let's see how lower blood sugar affects you. About 6 months
later it was clear that the retinopathy wasn't getting any worse, but
that there was damage that was not self-repairing, so I had the shot
first in one eye and then later on in the other. The shots worked quite
well for repairing the retinopathy, though they did cause cataracts.
After the cataracts were replaced, I did have some macular edema, and
steroid shots for that, which worked well again. I had one more of the
steroid shots after laser surgery that followed the development of a
secondary cataract in one eye.

Result of all this is that the retinopathy has not progresed one iota
since first dealt with, as my blood vessels no longer leak, and my
vision is better than it has been in 45 years following the cataract
surgery. Not only am I 20/25 in one eye, and 20/40 in the other (still
improving after the secondary cataract), but I also need reading
glasses only for very fine print.

I did have the blackout effect that Wendy described on the first of the
steroid injections, and it lasted about as long as it did for her, less
than 10 or 15 minutes, but have not had that happen since. I was given
adequate warning of the possible risks of all the procedures I have
undergone.

Morris

analog@logwell.com wrote:
> Yeah, you can learn to endure what you must. I recently started Byetta, and
> would have bet you money a few weeks back I would never self inject until the
> day I absolutely had to (as in the oral T2 meds no longer working). But here I
> am happy as a clam injecting lizard spit twice a day...
>
> Systemic steroids are indeed problematic with respect to BG control, but with
> careful medication monitoring, good results have been had. Dr. Hayreh was kind
> enough to correspond with me directly by email a couple of years back. He
> essentially agrees with my objections to both pan retinal and focal laser
> photocoagiulation as destructive procedures with a considerable downside. He
> has had a good deal of success with systemic steroid treatment of macular
> problems, some incredibly dramatic. Now the question is does the risk of
> injection of steroids or other agents directly into the eye outweigh the extra
> caution necessary to maintain BG control in diabetic patients undergoing
> systemic steroid therapy?
>
> I have a nagging concern here that profitability enters into the equation with
> most ophthalmologists. They do not stand to make much off systemic steroid
> treatment, and are faced with coordinating with the internist / endocrinologist
> concerning BG control. But a quick laser blast is worth a few thousand bucks,
> and I fear the injected steroids may be getting similar consideration. It is
> telling they did not do an adequate job of giving you adequate information for
> truly informed consent.
>
>
>
> On Sun, 26 Nov 2006 20:23:34 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote:
>
> >analog@logwell.com wrote:
> >: I refused the focal laser treatments, and it turned out to be a good call. I
> >: philosophically do not like ablative treatments; and I have heard of many cases
> >: where the cure was worse than the disease. If I get worse, I will consider
> >: either injections or systemic steroid treatment (with careful BG management).
> >: Incidentally, I experimented with steroid eye drops a couple of years back, but
> >: predictably saw little if any benefit. I am not sure if i could stand
> >: injections directly into the eye! I am not a very good patient when it comes to
> >: needles...
> >
> >I also found the idea rther gross, but they use an anesthetic in the eye
> >and it feels uncomfortable, but not painful. One thing to know, as Iwas
> >not wrned. When I had the first steroid shotI opened my eye and saw only
> >black, nothing at all! I ws being asked if ai could see fingers, etc andI
> >let out a yell likeI have never yelled before. It seems that the pressure
> >inthe eye went very high, resultin gin some seconds of totalblack. The
> >doctor ws getting ready to release some fluid from my eye when I becgan to
> >see first it looked like a window on a cold rainy day with steam on it and
> >a few trickles of clear and then rapidly cleared. When I asked why this
> >possibility had not been discussed with me they said it was very rare.
> >I said you told me there is a one in 1000 chance of infection, is this
> >less common than that and they said no, so I now warn people about this
> >scary short-lived possibility. The Avastin does not do this because the
> >volume of the drug is considerably less. Go for the injection as it works
> >directly where needed and don't try systemic steroid which, I imagine,
> >would be less affective and woudl wreak havoc with your bg control
> >unnecessarily. I never thught I woudl put up with all this stuff, but
> >when you need to, you just grit our teeth and do it.
> >
> >Wendy
> >