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    Improving visual function, retinal integrity in DME patient

    Case illustrates diagnosing and treating non-center involved DME


    Recommended Adjustments and Novel Therapy

    TR and I discussed the clinical findings, and I suggested that he get a continuous glucose monitoring system (CGMS) to better assess blood glucose patterns at various times of day and guard him against acute hypoglycemia. My goal was to minimize TR’s post prandial blood sugar spikes and reduce his HbA1c by 10 percent.

    I asked TR to minimize the duration of post meal hyperglycemia as much as possible via 15-minute pre-prandial insulin delivery, moderation of carbohydrate intake, and intramuscular injection of insulin when blood glucose levels are above 200 mg/dl.

    Related: Worldwide diabetes epidemic approaches half a billion

    In addition, I recommended that TR take a multi-component nutritional supplement (EyePromise DVS, ZeaVision). This formula has been shown to improve visual function (contrast sensitivity, color perception, and visual field sensitivity), blood lipids, hsCRP, and macular pigment as shown in a 6-month randomized control trial of adult diabetes (both type 1 and type 2) patients both with and without diabetic retinopathy, and without affecting HbA1c levels.8

    TR was asked to return in six months to assess his DME.


    TR’s color vision and contrast sensitivity improved in each eye. His last HbA1c value was 6.9 percent, and he reported high satisfaction with his CGMS. In particular, he reports less frequent acute hypoglycemia thanks to the CGMS alarm feature and fewer episodes of blood sugar levels >200 mg/dl.

    He has taken the recommended vitamin twice per day since his last visit, and his vision remains at 20/20 in each eye. Dilated fundus exam shows total resolution of hard exudate OD (Figure 2) with resolution of the subtle cystic DME on SD-OCT.

    TR will continue to be followed every six months for now.



    1. Varma R, Bressler NM, Doan QV, Gleeson M, Danese M, Bower JK, Selvin E, Dolan C, Fine J, Colman S, Turpcu A. Prevalence of and Risk Factors for Diabetic Macular Edema in the United States. JAMA Ophthalmol. 2014 Nov;132(11):1334-40.

    2. Zhang J, Ma J, Zhou N, Zhang B, An J. Insulin Use and Risk of Diabetic Macular Edema in Diabetes Mellitus: A Systemic Review and Meta-Analysis of Observational Studies. Med Sci Monit. 2015; 21: 929–936.

    3. Chung YR, Park SW, Choi SY, Kim SW, Moon KY, Kim JH, Lee K. Association of statin use and hypertriglyceridemia with diabetic macular edema in patients with type 2 diabetes and diabetic retinopathy. Cardiovasc Diabetol. 2017 Jan 7;16(1):4.

    4. Mason RH, West SD, Kiire CA, Groves DC, Lipinski HJ, Jaycock A, Chong VN, Stradling JR. High prevalence of sleep disordered breathing in patients with diabetic macular edema. Retina. 2012 Oct;32(9):1791-8.

    5. Diabetic Retinopathy Clinical Research Network. Protocol. Available at: http://drcrnet.jaeb.org/Studies.aspx. Accessed 12/19/17.

    6. Bhavsar KV, Subramanian ML. Risk factors for progression of subclinical diabetic macular oedema. Br J Ophthalmol. 2011 May;95(5):671-4.

    7. Banghoej AM, Nerild HH, Kristensen PL, Pedersen-Bjergaard U, Fleischer J, Jensen AEK, Laub M, Thorsteinsson B, Tarnow L. Obstructive sleep apnoea is frequent in patients with type 1 diabetes. J Diabetes Complications. 2017 Jan;31(1):156-161.

    8. Chous AP, Richer SP, Gerson JD, Kowluru RA. The Diabetes Visual Function Supplement Study (DiVFuSS). Br J Ophthalmol. 2016 Feb;100(2):227-34.

    Read more from Dr. Chous here


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