People once again can see loved one's faces, read, and watch TV, thanks to eye injections that fight diabetic macular edema, a common cause of blindness for people with diabetes (PWDs). The eye injections often preserve vision, and in about 30 percent of people they improve it in as little as two months. "It's really quite remarkable," says ophthalmologist Emily Y. Chew, M.D., of the National Eye Institute.
When injected into the eye on a regular basis, Lucentis (ranibizumab) reduces the blood leakage that can cause macular swelling. The medication blocks a chemical signal known as vascular endothelial growth factor (VEGF). The anti-VEGF drug inhibits the growth of new, abnormal blood vessels. People may need shots every few weeks to maintain their vision because the drug wears off. Researchers are looking for a longer-acting form of Lucentis that could be injected less frequently.
Lucentis does not eliminate the need for laser treatment, the standard therapy for diabetic macular edema, Chew says, adding that laser treatment has merits.
Point of View
Lloyd Davis, PWD type 2, receives Lucentis injections in his eyes every five weeks. "When it's time to get a shot, I can notice my reading is getting worse," says Lloyd, 58, about the blurry newspaper. A morning shot improves his vision by evening.
People cringe about the shots, Lloyd says. "But by the time I'm numbed, I don't feel a thing." Eyedrops and eyelid injections prepare and numb the eyes; discomfort varies by person.
Occasionally Lloyd will get a headache after eye treatments, and he is not supposed to rub his eyes for 48 hours after receiving the shot, but he doesn't complain. "It's well worth it," he says. "My daughter just had a baby, our first grandchild. If I hadn't done this, I probably wouldn't have seen him." The shots cost about $2,000 each; Medicare pays 80 percent of Lloyd's $30,000 annual treatment.
Adding one pill a day to an existing heart-health routine may prevent diabetic eye disease in certain PWDs type 2.
Chew led a subset of the government ACCORD (Action to Control Cardiovascular Risk in Diabetes) study of 10,000 people with type 2 diabetes who were at high risk for heart disease. Chew says the ACCORD Eye Study of 2,856 people found that adding a 160-milligram fibrate oral medication to a cholesterol-lowering statin pill cut the risk of developing diabetic eye disease by 30 percent in patients in the study.
Doctors already knew that a statin used to lower LDL (bad) cholesterol reduces heart risk, but adding the fibrate, which lowers triglycerides and raises HDL (good) cholesterol, helps prevent eye complications. "That's really huge," Chew says. "Prevention is so much better than having to treat on the other end." Fibrates (brand names include TriCor, Lipofen, and Antara) are easy to tolerate, Chew says.
The therapy isn't right for everyone, however, says endocrinologist Yogish Kudva, M.D., a lipids specialist at the Mayo Clinic in Rochester, Minnesota. The results of the ACCORD Eye Study apply only to people who have had type 2 diabetes for 10 years or more and who are at high risk for heart disease.
The conclusions can't be applied to people with type 1 diabetes, those who have had type 2 for less than a decade, or those whose triglyceride levels are lower than 150 mg/dl, Kudva says. The study also excluded participants who already had laser treatment for diabetic retinopathy. More research is needed to show whether fibrates, when added to blood glucose and cholesterol control, can prevent eye complications for PWDs who have lower cardiac risk.