Swollen Tear Duct: Symptoms, Causes, Treatments
Can An Eye Implant Treat Both Type 1 And 2 Diabetes?
About 537 million adults around the world have diabetes — a chronic condition where the body does not make enough insulin or properly use the insulin it makes.
While type 2 diabetes can be controlled — and possibly reversed — through lifestyle changes, type 1 diabetes is an autoimmune disease for which there is currently no cure.
In a new study, researchers from the KTH Royal Institute of Technology and Karolinska Institutet in Sweden have developed a tiny device that can be implanted into the eye to treat both types of diabetes and potentially other diseases.
The findings were published in the journal Advanced Materials.
For this study, the researchers developed a microscopic device for implantation into the eye.
The device is 3D printed, wedge-shaped, and is about 240 micrometers long. It is designed to be placed in the space between the iris and cornea called the anterior chamber.
The scientists reported that this new device allows specific microorganisms to be delivered directly through the eye without the need for sutures.
"The eye is, as we say, the 'only window into the body' where we can noninvasively monitor the transplant," Dr. Anna Herland, senior lecturer in the Division of Bionanotechnology at SciLifeLab at KTH Royal Institute of Technology and the AIMES research center at KTH Royal Institute of Technology and Karolinska Institutet, and co-lead author of this study explained to Medical News Today about what makes the eye a good candidate for this type of treatment.
"The eye is also immune privileged and avoids first immune reactions," she detailed.
The purpose of the tiny eye implant is to deliver microorganisms for disease treatment. The device was designed to have a micro-cage with a "flap door technique" to release the microorganisms.
In the case of treating diabetes, researchers used pancreatic islets — also known as islets of Langerhans — which are cells from the pancreas that can help restore insulin production.
"Cell transplants hold the promise of curing the disease and thereby avoiding lifelong treatments and the severe consequences of the disease. New technologies are, however, needed to drive the development of cell therapies for diabetes efficiently," Dr. Herland said.
During the study, researchers tested the eye implant device in a mouse model. They reported the device maintained its position in the eye for several months. When released, the microorganisms quickly integrated into the host animal's blood vessels and were able to detect glucose.
Dr. Herland said the progress of the therapy released into the eye by the device can be monitored through both normal blood sugar monitoring and observations through the cornea.
The researchers stated this microdevice could be a method to deliver cell-based treatment for other diseases through the eye.
"Ours is a first step toward advanced medical microdevices that can both localize and monitor the function of cell grafts. Our design will enable future integration and use of more advanced device functions such as integrated electronics or drug release."— Dr. Anna Herland
"This is a part of a larger effort where we are pushing device technology to monitor the function of transplanted islets," she continued.
"We have prototypes that can monitor islet function in vitro with electro-optical methods. We are now taking these prototypes for in vivo evaluations. We are also exploring how we can use the devices for drug release locally in the eye, thereby avoiding possible side effects at other sites in the body," she added.
For both type 1 and 2 diabetes, the main goal of treatment is to achieve a healthy blood sugar level in the body.
With type 1 diabetes, this is mainly through injections of insulin as well as additional medications.
Treatment for type 2 diabetes may also include medications and/or insulin therapy.
The main way of managing type 2 diabetes is through lifestyle changes, including eating right, regular exercise, getting enough sleep, and losing weight.
Doctors advise these same lifestyle modifications for type 1 diabetes as well.
A person's eyes are connected to the nerves and blood vessels that run throughout the rest of the body.
For this reason, an optometrist or ophthalmologist can detect signs of several diseases and health issues when performing an eye exam, including:
Additionally, an eye exam can find signs of diabetes. When the body has too much sugar in the blood, it can damage the blood vessels and nerves throughout the body, including the eyes.
Types of diabetic eye diseases are:
Medical News Today also spoke with Dr. David Geffen, director of optometric and refractive services at the Gordon Schanzlin New Vision in La Jolla, CA, about this study.
He said this study is a transformative investigation and may change the nature of diabetic treatment.
"The ability to implant a device in the eye to manage and produce the proper amount of insulin for patients will be a life-changing event. Diabetic patient compliance is a very big problem and the ability to manage this within the body is a huge step in preventing long-term damage typical in these individuals. The eye is the widow of many systemic diseases," Dr. Geffen added.
"Diabetic retinopathy is a major cause of vision loss in the world. Controlling sugar and insulin levels is paramount to keep the eye and other organs in proper shape. The next steps will be to determine that this implant has no side effects within the eye, as well as how well controlled the patient's levels will be maintained."— Dr. David Geffen
Screening For Diabetic Eye Disease Every 2 Years For Those At 'low Risk' Could Risk Treatment Delays And/or Sight Loss
Extending the annual screen by a year for people in England considered to be at low risk of diabetic eye disease (diabetic retinopathy) could risk critical treatment delays and/or sight loss, suggests a large, real world data study, published online in the British Journal of Ophthalmology.
Early treatment is vital to stave off blindness, say the researchers. A biennial screening delayed hospital referral by 12 months among around half of those who developed serious diabetic eye disease, with those at either end of the age spectrum and of Black ethnicity most at risk, the findings indicate.
A review and update of the diabetic eye screening program standards and their reporting requirements is now overdue, concludes a linked editorial.
The NHS introduced an eye screen (DESP) in 2003 for people in England with type 1 or 2 diabetes from the age of 12 onwards, with the aim of picking up diabetic eye disease—damage to the delicate network of tiny blood vessels at the back of the eye—for which early treatment is essential to stave off sight loss.
Since 2016, the UK National Screening Committee has recommended annual eye checks for those at high risk of sight loss, and biennial checks for those considered to be at low risk, in light of evidence indicating that this interval is safe and cost effective amid rising demand for the service, explain the researchers.
Already in place elsewhere in the UK, it is now being implemented in England. But it's not clear what clinical and other impacts this change might have, say the researchers. To plug this knowledge gap, they drew on one of the largest most ethnically diverse diabetic screening programs in North East London. They tracked the eye health of 82,782 people with diabetes but with no diabetic eye disease in either eye on two previous consecutive screens between 2012 and 2021. Over a third were of white (36%) or of South Asian (37%) ethnicities; 16% were Black.
Over 8 years, they looked at the numbers of those developing the condition, their ethnicity and age as well as the implications of potential delays in referral for treatment as a consequence of biennial rather than annual eye checks.
During this period, 1,788 new cases of moderate to severe (sight threatening) diabetic eye disease were picked up in people regarded as being at low risk: 103 of these had the proliferative form (PDR)—the most severe type associated with late-stage damage that carries a very high and short term risk of blindness and requires urgent referral.
Men had lower rates of sight threatening diabetic eye disease than women, and those with type 1 diabetes had higher rates than people with type 2 diabetes. There was no clear pattern across levels of deprivation.
But striking ethnic differences emerged over time. Case rates were significantly higher among Black people, who were 121% more likely to develop sight-threatening diabetic eye disease than white people, while South Asian people were 54% more likely to do so.
Based on these figures, extending the annual eye check to every 2 years would have delayed diagnosis by 12 months in more than half (1,007; 56.5%) of those with sight threatening disease and in nearly half (44%; 45) of those with PDR.
The diagnostic delays stratified by ethnic group were 256/30,350 among white people; 379/29,730 among South Asian people; and 256/13,391 among Black people—equivalent to 844, 1,276, and 1,904 per 100,000 screened, for each ethnic group, respectively.
For PDR, numbers were much lower, but rates were still higher among Black people (90/100,000) compared with white people (46/100,000). Progression to sight-threatening diabetic eye disease was also more pronounced in the youngest (under 45) and oldest (65+) than it was in those in their mid-40s to 60s.
Diagnostic delays stratified by age were highest among the under-45s (1,504 per 100,000 screened) and among those aged 65 and older (1,248) compared with 1,178/100,000 among 45-to-54-year-olds and 987 among 55-to-64-year-olds.
The researchers acknowledge various limitations to their findings, including the use of annual screening data to simulate biennial screening.
But they write, "Given these sociodemographic differences, we have shown that introducing biennial as opposed to annual diabetic eye screening could worsen sight loss among certain sociodemographic groups because of delayed detection of [sight threatening diabetic retinopathy] and PDR, potentially adding to health care inequalities."
They also emphasize, "The incentive of biennial screening is to release capacity in the NHS and lessen the inconvenience for [people with diabetes] at low risk of sight loss of attending eye screening appointments every year, but there is a need to address the potential to amplify ethnic and age inequalities in health care."
They go on to suggest that "artificial intelligence (AI) technologies could be used to assist in maintaining the current status quo in screening frequency." But despite their well evidenced effectiveness in reducing the human workload of grading retinal images for diabetic eye disease, automated systems, which have been used in Scotland for over a decade, aren't currently licensed for use in the English NHS DESP.
In a linked editorial, Drs. Parul Desai and Samantha De Silva of—respectively—Moorfields Eye Hospital London and the Oxford Eye Hospital and University of Oxford, comment, "Given the significant change in service delivery that has either already taken place or is imminent, and the evidence now available, a review and update of DESP standards and their reporting requirements (last undertaken in 2019), should be planned to take account of the differential impact among subgroups of the population eligible for diabetic eye screen."
They add, "Introducing a requirement to report by age and ethnicity for selected screening standards would enable regular, prospective monitoring of changes to service delivery, so disparities do not remain unrecognized, and provide information for responsive action on any unwarranted variation…. Because one size may not always fit all."
More information: Two-year recall for people with no diabetic retinopathy: a multi-ethnic population-based retrospective cohort study using real-world data to quantify the effect, British Journal of Ophthalmology (2023). DOI: 10.1136/bjo-2023-324097
Citation: Screening for diabetic eye disease every 2 years for those at 'low risk' could risk treatment delays and/or sight loss (2023, October 24) retrieved 25 October 2023 from https://medicalxpress.Com/news/2023-10-screening-diabetic-eye-disease-years.Html
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Understanding Common Eye Problems, Treatments
DUBOIS — Naturalist Henry David Thoreau said, "The eye is the jewel of the body." But just like jewels that can have imperfections that disrupt the normal crystal structure, our eyes can experience disorders that can cause vision impairment or general discomfort.
Fortunately, physicians who are experts in eye care use a variety of treatments — from glasses and contacts to medications and minimally invasive procedures to treat common eye conditions.
According to the Centers for Disease Control and Prevention (CDC), refractive errors are the most frequent eye problems in the United States. Refractive errors include myopia (near-sightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances) and presbyopia that occurs from 40 to 50 (loss of the ability to focus up close and the need to hold newspaper farther away to see clearly). These refractive errors can be corrected with eyeglasses, contact lenses or in some cases surgery. The National Eye Institute states that proper refractive correction could improve vision among 150 million Americans.
What are common eye conditions?
In addition to refractive errors, there are several other common eye conditions that include: Amblyopia (lazy eye), blocked tear ducts, cataracts, conjunctival injuries, cornea injuries, diabetic eye, double vision, droopy eyelids, dry eye syndrome, eye infections, eyelid injuries, lesions/cysts or spasms, facial spasms, flashes/floater, glaucoma and macular degeneration.
InfectionsEye infections can be caused by many different organisms, including bacteria, viruses, amoeba and fungi. Symptoms can include pain, redness, blurred vision, sensitivity to light, excessive tearing and discharge.
"Any time there is a concern with the eyes, it should be taken very seriously," explained Dr. Perry Ward Younger, a board-certified ophthalmologist at Penn Highlands Eye Center in St. Marys. "Many eye infections are not serious and can be treated with antibiotic drops. If you have any of the symptoms of infection, seek treatment, and if you wear contacts, remove them as soon as possible."
Dr. Younger continued, "An uncommon but serious source of eye infections come from inappropriately managed hot tubs. Pseudomonas can grow in hot tubs commonly if the level of chlorination is not handled properly. I have personally witnessed a patient lose an eye within one week of exposure to a few drops of contaminated hot tub water being splashed in his eye."
AmblyopiaAn estimated 2% to 3% of the population suffer from amblyopia or lazy eye which is the most common cause of vision impairment in children. Amblyopia occurs when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. While the eye appears normal, it is not working correctly because the brain is favoring the other eye. Certain conditions can lead to a lazy eye including an imbalance in the positioning of the two eyes; more nearsighted, farsighted or astigmatic in one eye than the other; and cataracts. Symptoms include squinting, shutting one eye and tilting the head. Unless treated in childhood, amblyopia persists into adulthood and can cause permanent one-eye vision impairment. Treatments can range from treating the vision problem causing the lazy eye, such as wearing glasses to the use of temporarily wearing an eye patch or using special drops in the stronger eye to blur the vision and make the brain force the use of the other eye.
"It is important to treat children with a lazy eye early," said Dr. Younger. "Children who grow up without treatment have lifelong vision problems. Screenings occur by pediatricians as well as primary care providers. Teachers can likewise be vigilant looking for signs such as difficulty reading or squinting in classrooms."
GlaucomaGlaucoma can damage the eyes' optic nerve and result in vision loss and blindness. It can occur when the normal fluid pressure inside the eye slowly rises. There is no cure for glaucoma, but early treatment can often stop the damage and protect your vision. In the early stages, no symptoms appear and nearly half of the people do not even know they have it. Glaucoma progresses slowly with side (peripheral) vision and people still do not realize that their vision is changing. As the disease worsens, those with glaucoma notice that they cannot see objects off to the side. Doctors use different treatments for glaucoma including eye drops, laser procedures to lower eye pressure and surgery. In summary, glaucoma should be thought of as a severe disease. It has been said that even in the early stages, it is a "severe disease caught at an early stage."
CataractAccording to the CDC, an estimated 20.5 million (17.2%) Americans over age 40 have a cataract in one or both eyes, and 6.1 million (5.1%) have had their lens removed operatively. Cataract, a clouding of the eye's lens, is the leading cause of vision loss in the U.S. And the leading cause of blindness worldwide. Cataracts can occur at any age because of a variety of causes, and can be present at birth; however, they are very common as people age. In fact, more than half of all Americans over age 80 either have cataracts or have had surgery to remove the cataracts. In the early stages, cataract symptoms are mild. They may range from blurry vision and decreased night vision to double vision or seeing a halo around lights.
"While home treatments may be effective at first, such as using magnifying lenses for reading and other activities or seeking a new prescription for glasses or contacts, surgery is the only way to remove the clouded lens. The surgery is very safe and effective," added Dr. Younger.
A recent statistic cited that we are behind schedule of approximately 250,000 cataract surgeries in the U.S. Because of the temporary COVID-19 closures in the U.S. Compounded to that is the continued growth of the baby boomer population who are now coming of age for surgery consultation in our country. Because many of these patients have undergone various forms of refractive surgery, they pose unique challenges to the correction selection of replacement intraocular lens implant.
To learn more, visit www.Phhealthcare.Org/eyecare/.
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