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Detecting Diabetes Eye Damage Early

Indiana University researchers have detected new early-warning signs of the potential loss of sight associated with diabetes. This discovery could have far-reaching implications for the diagnosis and treatment of diabetic retinopathy, potentially impacting the care of over 25 million Americans. The study was published in April 2014 in the journal Biomedical Optics Express.

A release from the university quotes lead author Ann Elsner, professor and associate dean in the IU School of Optometry, as saying, "We had not expected to see such striking changes to the retinas at such early stages.We set out to study the early signs, in volunteer research subjects whose eyes were not thought to have very advanced disease. There was damage spread widely across the retina, including changes to blood vessels that were not thought to occur until the more advanced disease states,”

These important early-warning signs were invisible to existing diagnostic techniques, requiring new technology based on adaptive optics. Stephen Burns, professor and associate dean at the IU School of Optometry, designed and built an instrument that used small mirrors with tiny moveable segments to reflect light into the eye to overcome the optical imperfections of each person's eye.

"It is shocking to see that there can be large areas of retina with insufficient blood circulation," he said. "The consequence for individual patients is that some have far more advanced damage to their retinas than others with the same duration of diabetes."

Because these changes had not been observable in prior studies, it is not known whether improved control of blood sugar or a change in medications might stop or even reverse the damage. Further research can help determine who has the most severe damage and whether the changes can be reversed.

Diabetes has long been known to damage the retina, the irreplaceable network of nerve cells that capture light and give the first signal in the process of seeing. This damage to the retina, known as diabetic retinopathy, is the leading cause of vision loss in the U.S. for individuals under the age of 75.

The changes to the subjects in the study included corkscrew-shaped capillaries. The capillaries were not just a little thicker, and therefore distorted, but instead the blood vessel walls had to grow in length to make these loops. This is visible only at microscopic levels, making it difficult to determine who has the more advanced disease among patients, because these eyes look similar when viewed with the typical instruments found in the clinic. Yet, some of these patients already have sight-threatening complications.

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