Wilmer clinic looks to early care to fight diabetic blindness SIGHT SAVERS

March 29, 1994|By Chris Kaltenbach | Chris Kaltenbach,Sun Staff Writer

Arnold Ray believes he owes his vision to a free diabetic eye screening program offered by the Johns Hopkins Hospital's Wilmer Eye Institute.

Spurred on by the American Academy of Ophthalmology's Diabetes 2000 Project, a campaign to eliminate preventable diabetic blindness by the turn of the century, doctors at the Wilmer decided in November 1992 to begin offering free eye checks. Since then, 189 people have taken advantage of the offer, says Dolores Rytel, who coordinates the screening program.

If problems are detected, patients and their physicians are told of the diagnosis. Corrective laser surgery, remarkably successful in treating diabetes-related eye problems, can be performed right there at the Wilmer.

Mr. Ray, an engineering construction inspector living in Severn, had been living with diabetes since age 9. He knew diabetics were prone to eye problems that could lead to blindness, but when he began suffering from headaches and blurred vision about a year ago, the father of two figured a trip to the optometrist and some new glasses would take care of everything.

Fortunately, a family member had read about the Wilmer's screenings. If one of the best eye-care facilities in the country was offering to see him for free, Mr. Ray figured, who was he to turn the offer down? And the timing was perfect, since he recently had changed jobs and his new health insurance would not cover pre-existing conditions such as diabetes.

His trip to the Wilmer revealed that Mr. Ray was indeed suffering from diabetic retinopathy, a condition that affects the vessels supplying blood to the retina. Left untreated, it can lead to blurred or spotty vision and eventual blindness. But ophthalmologists at Wilmer, by training a laser on the affected blood vessels, can slow down and often stop the degenerative affliction.

The doctor "said everything went well, that it looks very good," says Mr. Ray, who has made between seven and 10 return visits to Wilmer. "Had I not had the laser, the doctor said I would have been permanently blind in both eyes in about a year."

Diabetes, which affects the body's ability to break down sugars, used to be fatal all by itself. But that changed with Dr. Frederick Banting's discovery of insulin in the 1920s. Today, diabetics are able to lead active lives by monitoring the level of sugar in their blood and, for many, injecting themselves with insulin once or twice a day.

Most diabetics -- there are an estimated 250,000 in Maryland, about 10 percent of whom suffer from the more severe form, known as juvenile diabetes -- will be touched by some sort of complication resulting from the disease. Those could include kidney failure, heart disease and neuropathy (a deadening of nerves, most frequently in the hands and feet), in addition to retinopathy.

The American Diabetes Association of Maryland estimates 260 cases of blindness each year can be attributed to complications from diabetes.

Such numbers make it the leading cause of blindness in the United States, Mrs. Rytel says.

Sadly, most of those people would still have their vision had an ophthalmologist detected the condition early enough and started treatments. Most of the problems caused by retinopathy start so unobtrusively that they are almost impossible for the patient to detect. By the time symptoms become noticeable, the damage may already be done.

"We want everyone to know, physician and patient, that they should be taken care of before problems develop," says Dr. William Finkelstein, one of nine ophthalmologists at the Wilmer who specialize in diseases of the retina. "It can occur at any time. There's no way for the person with diabetes to recognize [the condition] early on. There are no symptoms at that stage."

Dr. Finkelstein says almost all diabetics will show signs of diabetic retinopathy at some point in their lives. About half should undergo laser treatments.

While acknowledging there's no such thing as a 100 precent cure, he estimates ophthalmologists are successful in preventing either blindness or severe vision loss 90 percent of the time.

"We're very good at preventing a disaster if we catch it early," Dr. Finkelstein says. "We can treat [the condition] very well with the laser."

Wilmer's a wonderful institute," says Tim O'Neill, executive director of the Maryland Chapter of the Juvenile Diabetes Foundation. "Eye problems are one of the leading complications arising from diabetes. A program like this gives us the opportunity to do something about that."

Mr. O'Neill says his organization is publicizing the Wilmer's program through its newsletter and support groups.

If not for the free screenings, diabetics would have to pay anywhere from $40 to $100 to have their eyes checked for retinopathy, Dr. Finkelstein says. The laser treatments, which can cost several thousand dollars, are covered by most health insurance plans.

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