Beetham Eye Institute

Our Approach to Eye Care

Even though diabetes is the leading cause of adult-onset blindness, vision loss due to diabetic retinopathy can be prevented.

Joslin Diabetes Center has been at the forefront of diabetes-related eye disease prevention since its inception and has set standards across the world for the treatment and care of eyes. At Joslin, we have developed clinical guidelines that recommend you take a three-pronged approach to preserving your vision:

1. Maintain good A1C levels.
2. Keep blood pressure and other health factors in check.
3. Be vigilant about getting eyes checked annually through a dilated eye exam (where the doctor places drops in your eyes) or specially validated photographs of your retinas (Joslin Vision Network).

Diabetic retinopathy is the most common eye disease for people with diabetes. It occurs when the small blood vessels in the eye are damaged by high levels of glucose in the blood. Although there are a variety of treatments to treat diabetic retinopathy, the earlier it is diagnosed, the more effective the treatment. Take charge of your eye health and make sure that an annual eye exam is part of your comprehensive treatment plan.

Don’t Wait for Symptoms

Diabetic retinopathy occurs when the tiny blood vessels inside the retina — the tissue at the back of the eye that sends images to the brain — become damaged. There are usually no symptoms at this early “nonproliferative” stage. Essentially all people with diabetes will eventually develop some changes in the retina, usually within 20 years of diabetes onset.

In two-thirds of cases, this type of retinopathy progresses to the “proliferative stage,” although research shows that intensive glucose and blood pressure control can delay the onset of disease and slow its progression. In the proliferative stage, the retina forms new vessels in an attempt to circumvent nonfunctioning blood vessels. These new vessels, however, are abnormal, fragile and bleed readily.

If the condition is treated with laser photocoagulation when the abnormal vessels are in their early stages, severe vision loss can be prevented in about 95 percent of cases. The laser scars the retina, causing the vessels to regress, which prevents subsequent bleeding and pulling on the retina. Since the laser destroys some areas of the retina, there may be side effects of treatment — such as reduced side or night vision — but central vision is retained far better than if the patient receives no treatment at all.

Diabetic macular edema, however, is a different story. Diabetes can cause the retinal vessels to leak, leading to swelling of the retina. If this swelling occurs in the small area in the center of the retina called the macula, the condition is called macular edema. Vision can decline because this area of the retina is responsible for central vision. Laser treatment is also used for this condition but is less successful than when used for new vessels. Treatment reduces the chance of vision worsening by only half, and even when successful, is usually not associated with improved vision.

This is why everyone with diabetes should get annual eye checks and keep blood glucose, blood pressure, and cholesterol in good control.

New Treatments to Prevent Vision Loss

The Beetham Eye Institute at Joslin Diabetes Center is a world leader in research on diabetic eye disease. Our top researchers are making major discoveries that can help clinicians worldwide treat diabetic eye disease and prevent vision loss.

Joslin is involved in nearly every major clinical trial in the treatment and prevention of diabetic retinopathy and macular edema in the United States. Some of our recent clinical trials have evaluated innovative therapies, including:

• PKC-beta inhibitor (taken as a pill) to slow progression of vision loss (pending FDA approval)
• Laser and surgical treatments for diabetic macular edema
• Growth factor inhibitors and steroids injected into the eye to reduce macular edema and improve vision

New patients receive a complete eye exam, as well as access to the latest diagnostic technology, including:

• Digital imaging
• Standardized ultrasonography
• Optical coherence tomography
• Multifocal electroretinography
• Scanning laser ophthalmoscopy
• Retinal blood flow measurements

Most patients receive an evaluation by an ophthalmologist and an optometrist at each visit. If the evaluation shows any eye problems, your doctor will personally discuss the results with you, educate you on your condition, answer questions, and make a plan for treatments and follow-up care.

Should you need treatment, our caring team includes experts in:

• Cataract and anterior segment surgery
• Vitreoretinal disease and surgery
• Ocular telemedicine
• Vision rehabilitation
• Contact lens fitting and dispensing

Clinical Trials

As a patient of the Beetham Eye Institute, you may also be considered for participation in one of our many ongoing clinical trials. Clinical trials offer access to the newest treatment approaches for diabetic eye disease.

How to Prepare

If you're a new patient at the Beetham Eye Institute, please arrive a half-hour before your appointment to register and bring the following with you:

• Your insurance card
• Copies of materials from any previous eye exams (or arrange to have them sent to us)
• Eyeglasses, contact lenses, or any other visual aids you use
• A list of medications to which you are allergic
• A list of prescription medications you take, as well as any over-the-counter medications or supplements
• Sunglasses if you are having your eyes dilated

If you have your eyes dilated during your examination, you should not plan to drive directly afterward.

Eye appointments involve very thorough and delicate examinations. Exams on average last approximately 2½ hours.