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UI ophthalmologist focuses on eye diseases, education related to diabetes

IOWA CITY, Iowa -- A major concern among people with diabetes is loss of vision, a long-term complication of the illness and the cause of blindness for more than 8,000 to 12,000 Americans each year. A University of Iowa College of Medicine professor is working to better educate both the public and other health care professionals on diabetes-related vision loss, and to study the effectiveness of one type of eye surgery on diabetes patients.

"The longer a person has diabetes, the greater chance that person will have some diabetes-related damage to the retina that can result in vision loss," says Dr. Karen Gehrs, UI assistant professor of ophthalmology and a retina specialist at the UI Hospitals and Clinics. "Blindness from diabetes is preventable in most cases, if problems are detected early. Currently, however, almost half of patients with diabetes in the United States are not undergoing the recommended screenings to detect eye disease at a stage where it can be treated successfully."

Gehrs is the Iowa coordinator for Diabetes 2000, a nationwide project started in 1989 by the American Academy of Ophthalmology. Aimed at patients, physicians and other health care professionals, the project's goal is to eliminate preventable blindness from diabetes through education and public awareness.

Gehrs is developing educational materials about diabetic retinopathy (disorders of the retina that result in vision loss) for physicians who care for diabetic patients at the UI and around the state. "With a simple education strategy, we can increase physicians' awareness and emphasize the need for eye examinations," she says.

Increasing pharmacists' awareness about diabetes-related eye disorders is another avenue for prevention. Working with faculty at the UI College of Pharmacy, Gehrs is developing lectures and presentations to be included in the college's pharmaceutical care curriculum.

Gehrs is also helping UI pharmacy faculty prepare a diabetes education program that pharmacists can implement at their practices. This includes informational materials that pharmacists will share with their patients and a continuing education program for pharmacists. "There is also the possibility that pharmacists could check blood sugar or blood pressure when a diabetes patient comes in to pick up a prescription, and keep a database of the patients' visits," Gehrs says. "Then, when a patient goes to see his or her doctor, there is an updated log detailing their condition." Pharmacists' accessibility and regular contact with diabetes patients who take medications would help make the program viable, she notes.

(more) 5/22/97

In areas of research, Gehrs is studying the effectiveness of vitreous surgery for a type of swelling of the retina called diabetic macular edema (DME). DME is a problem for many diabetes patients and is a result of poor circulation in the macula, or central part of the retina, where vision should be clearest.

"Think of the blood vessels in the macula as a network of capillaries. DME occurs when capillaries become damaged and 'holes' develop in this network," Gehrs says. The surrounding capillaries can compensate for these damaged or missing blood vessels but eventually the area of missing or damaged circulation becomes so large that the surrounding vessels just can't keep up. The cells supplied by the damaged or missing capillaries then become suppressed, the retina swells, and vision decreases.

Laser surgery does help many people with DME, Gehrs notes, but some side effects do exist -- patients may see little spots or notice that things "look dull" even though their visual acuity may be the same or even improved. "Additionally, 25 to 35 percent of laser-treated patients will still have persistent DME after the procedure," she says.

Gehrs is beginning a collaborative study with researchers at the Medical College of Wisconsin that involves surgical removal of the vitreous humor, the transparent, jelly-like material that fills the chamber of the eye behind the lens. Previous studies have suggested that removing the vitreous humor (a procedure known as a vitrectomy) may improve the amount of oxygen that reaches the retina. Vitrectomies have been used for years to remove hemorrhages from the eyes of diabetics with proliferative retinopathy, or abnormal new blood vessels. Doing a vitrectomy to treat DME, however, is a fairly new idea.

Working with 50 diabetes patients, researchers will look at patients who have DME despite already having undergone one or two laser treatments. "Basically, we will offer these patients a vitrectomy or another laser treatment," Gehrs says. "A few pilot studies have been done with vitrectomies for DME and some have reported high success rates -- sometimes in the 90 percent range. But in those studies, no comparison was done between laser and vitrectomy. Some patients in those studies may have gotten better with laser treatment alone. In this study, we want to concentrate only on those patients who don't respond to the initial one or two laser procedures." Gehrs thinks there may be a subset of patients who do not respond to laser treatment and who may be better off with vitrectomy before they've undergone many laser sessions for macular edema.

Gehrs' interest in diabetes-related eye disorders stems partly from the positive impact ophthalmologists can have in maintaining a diabetic patient's vision. "Diabetic patients often have a myriad of health concerns," she says. "If we can keep a patient's vision stable and reduce the risk of blindness, we can make an enormous impact on their quality of life and their ability to remain independent."