[Jill-O]

Hi there and good luck with your treatment!!!

Since my original post here, I've had the Avastin shots periodically, and they do help (and aren't painful). I've had mild laser surgery in the right eye, too.

However, about a month ago, I had to have more heavy duty laser surgery and it was painful afterwards for a few days with my eyelid all swollen, too. My eye is still dilated nearly 1 month post surgery (I am seeing the doctor frequently). On Thursday, I got an anti-inflamatory shot in the eye to reduce the swelling (apparently still from the surgery)?

AND, my eye is still tremendously dilated. Not a real happy camper right now. Doctor assures me it will go down. I see him now in two weeks again. We still need to do Lefty... not as bad as my right eye, but I am not looking forward to having this done again.

The mild laser surgery for me had no recovery time. It was easy, easy. This recent one really has thrown me for a loop and has not been what I expected.

Also, my Doctor does the pictures, too, with the florescent dye injection as well. I have had 4 or 5 sets so far.

I don't think my recent surgery is a typical situation in terms of recovery and all this swelling but the doctor said it's not unusual either, which makes me feel better. Last thing I want to hear one of my doctors say is "huh, now that's something I never saw before!"

Jill

[xMenace]

Welcome to the laser club!

[Achilles]

Hi Jill. Thanks for your response and sorry to hear about your recent troubles. Hopefully things get better for you like the doc says.

I've still been in kind of shock over this macular edema thing for the weekend. My luck has been terrible. Only 7 - 10% of newly diagnosed T2s have retinopathy and only about 10% of those have macular edema. This is making me think I have had diabetes for a long time. How two different eye doctors I have been going to for regular checkups didn't pick anything up I don't know. Unless it is really this "early worsening" effect I am experiencing.

Then to get the "early worsening" with the macular edema is even more of a double-whammy. Early worsening occured in about 13% of the patients in the DCCT Study. I've learned a lot about diabetes in the past few months and worked hard on getting my A1c down but really know nothing about macular edema. All I know is that I saw a picture like a cross section of my retina where it was swollen. It is not affecting my vision at this point.

To top all of this off, I'm going in tomorrow to the original opthamologist for an optic nerve analysis. I got this done last year too. Apparently I'm also pre-glaucomic or in the danger zone here. My numbers are 17 - 20 mm (not sure about units of pressure) but because I had LASIK over 10 years ago the cornea is a little thinner and these numbers have to be adjusted accordingly says the doctor. I don't know much about this either. Last year my optic nerve analysis was good but I didn't have retinopathy either.

Sorry if this sounds like I'm venting a little. All I can do is work on getting my A1c down below 6.0 and hope and pray.

[Achilles]

Here's a reference to the DCCT study my doctor mentioned.

Arch Ophthalmol -- Abstract: Early Worsening of Diabetic Retinopathy in the Diabetes Control and Complications Trial, July 1998, The Diabetes Control and Complications Trial Research Group 116 (7): 874

Early Worsening of Diabetic Retinopathy in the Diabetes Control and Complications Trial

The Diabetes Control and Complications Trial Research Group

Arch Ophthalmol. 1998;116:874-886.

Objectives To document the frequency, importance of, and risk factors for "early worsening" of diabetic retinopathy in the Diabetes Control and Complications Trial (DCCT).

Methods The DCCT was a multicenter, randomized clinical trial comparing intensive vs conventional treatment in insulin-dependent diabetic patients who had no to moderate nonproliferative retinopathy. Retinopathy severity was assessed in 7-field stereoscopic fundus photographs taken at baseline and every 6 months. For this study, worsening was defined as progression of 3 steps or more on the Early Treatment Diabetic Retinopathy Study final scale, as the development of soft exudates and/or intraretinal microvascular abnormalities, as the development of clinically important retinopathy, or as any of the above, and was considered "early" if it occurred between baseline and 12-month follow-up visits.

Results Early worsening was observed at the 6- and/or 12-month visit in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment (odds ratio, 2.06; P<.001); recovery had occurred at the 18-month visit in 51% and 55% of these groups, respectively (P=.39). The risk of 3-step or greater progression from the retinopathy level present 18 months after entry into the trial was greater in patients who previously had had early worsening than in those who had not. However, the large long-term risk reduction with intensive treatment was such that outcomes in intensively treated patients who had early worsening were similar to or more favorable than outcomes in conventionally treated patients who had not. The most important risk factors for early worsening were higher hemoglobin A1clevel at screening and reduction of this level during the first 6 months after randomization. We found no evidence to suggest that more gradual reduction of glycemia might be associated with less risk of early worsening. Early worsening led to high-risk proliferative retinopathy in 2 patients and to clinically significant macular edema in 3; all responded well to treatment.

Conclusions In the DCCT, the long-term benefits of intensive insulin treatment greatly outweighed the risks of early worsening. Although no case of early worsening was associated with serious visual loss, our results are consistent with previous reports of sight-threatening worsening when intensive treatment is initiated in patients with long-standing poor glycemic control, particularly if retinopathy is at or past the moderate nonproliferative stage. Ophthalmologic monitoring before initiation of intensive treatment and at 3-month intervals for 6 to 12 months thereafter seems appropriate for such patients. In patients whose retinopathy is already approaching the high-risk stage, it may be prudent to delay the initiation of intensive treatment until photocoagulation can be completed, particularly if hemoglobin A1c is high.


From the Diabetes Control and Complications Trial Research Group, Bethesda, Md. A complete listing of the Diabetes Control and Complications Trial Research Group is published in the Archives of Ophthalmology (1995;113:49-51).

[Jill-O]

Achilles --

I can very much relate to how you are feeling and also to the hunch that you've had diabetes for a long time. I think that's the case with me as well.

One thing that really scared me at one point was my kidneys. I remembered about 6 mos into diagnosis that my OBGYN said there had been sugar / protein in my pee and referred me to my diabetes doctor (new to me then). I honestly didn't think of it again, just worked on getting my numbers down, until the eye stuff started happening.

So, in talking with my regular doctor, he had me do that 24 hour urine collection thing. I was so scared, it was like knees of jello time. I was sure my kidneys were failing based on if diabetes had done this to my eyes...

Long story short, my kidneys are fine. I wanted to tell you this in case you do like me and start thinking about what else may be wrong.

Good luck,
Jill