diabetic retinopathy

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Routine eye scans may give clues to cognitive decline in diabetes

Ophthalmology Exam of Patient with Diabetes CREDIT Beetham Eye Institute/Joslin Diabetes Center

As they age, people with diabetes are more likely to develop Alzheimer’s disease and other cognitive disorders than are people without diabetes. Scientists at Joslin Diabetes Center now have shown that routine eye imaging can identify changes in the retina that may be associated with cognitive disorders in older people with type 1 diabetes.

These results may open up a relatively easy method for early detection of cognitive decline in this population, providing better ways to understand, diagnose and ultimately treat the decline, said George L. King, MD, Joslin’s Chief Scientific Officer and senior author on a paper about the study in the Journal of Clinical Endocrinology & Metabolism.

Previous research had demonstrated an association between proliferative diabetic retinopathy (PDR, a complication of diabetes that can severely damage eyesight) and cognitive impairment in people with type 1 diabetes. “Since we knew that there were cellular changes in the retina that might reflect changes in the brain, we were interested to see whether imaging techniques that visualize those changes in the retina might be reflective of changes in cognitive functions,” said Ward Fickweiler, MD, a Joslin postdoctoral fellow and first author on the paper.

The scientists drew on eye scans routinely gathered from patients as part of normal vision care at Joslin’s Beetham Eye Institute. One set of scans was based on optical coherence tomography (OCT, a technique employing light to provide cross-sections of the retina). A second set of scans employed OCT angiography (OCTA, an extension of OCT technology that examines blood vessels in the retina). Both types of scans are non-invasive and widely available in eye clinics in the United States, and can be performed within minutes.

The study enlisted 129 participants in the Joslin Medalist Study, which examines outcomes among people who have had type 1 diabetes for 50 years or longer. These volunteers took a series of cognitive tests that included tasks probing memory function as well as psychomotor speed (assessing the time it took to arrange objects by hand).

Strikingly, the researchers found very strong associations between performance on memory tasks and structural changes in deep blood vessel networks in the retina. “Memory is the main cognitive task that is affected in Alzheimer’s disease and cognitive decline, so that was exciting,” Fickweiler said.

The Joslin team also discovered strong associations between PDR and psychomotor speed. This finding reinforced earlier outcomes that had been identified among a smaller group of Joslin Medalists, and provided details about related changes in retinal structure. Additionally, the researchers saw that PDR was associated with memory performance among the larger group of Medalists.

While these results need to be confirmed in larger clinical investigations, the routine eye exams do seem to detect the cognitive changes happening in people with diabetes, said Fickweiler.

Currently, other ways to detect conditions such as Alzheimer’s disease such as MRI scans are difficult and expensive. People typically are tested only when they’re showing symptoms of cognitive decline and treatments at that stage generally don’t offer much help.

“If you can detect the condition at an earlier stage, when they’re still asymptomatic, that may benefit patients,” Fickweiler said. Earlier detection also could aid the quest to develop better therapies for neurocognitive diseases.

The Joslin team plans to launch a larger prospective study to confirm the potential of eye imaging to pick up signs of cognitive decline over time. This research will include people with type 1 diabetes who are younger and haven’t had the disease for as long as the Medalists. The scientists also will analyze MRI brain images and postmortem brain samples donated by Medalists.

Additionally, the investigators will look for common mechanisms that may inflict damage on brain and retina tissues, which share much of their early embryonic development pathways. Likely suspects in people with diabetes include impaired blood vessels and high or low levels of blood glucose. The autoimmunity that drives type 1 diabetes also might inflict other forms of harm, King said.

Notably, Joslin Medalists often display relatively low levels of the complications that can afflict those with long-term type 1 diabetes. For instance, almost half of Medalists don’t develop advanced eye disease, and only one of the 129 Medalists in the eye-scan study may have Alzheimer’s disease. “It is possible that in the Medalists, a shared mechanism alters the progression of the early stages of retinal and brain neurodegeneration, and provides protection against both PDR and Alzheimer’s disease,” Fickweiler speculated.

In addition to follow-up work in type 1 diabetes, King and his team plan to perform a similar study for people with type 2 diabetes. PDR also is associated with cognitive decline in this much larger group of patients, who also get OCT and OCTA eye scans as part of their regular vision care.

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Diabetes – Treatment , Complication and Prevention of Diabetes – An interview with Dr Max Pemberton


Diabetes - Treatment , Complication and Prevention of Diabetes - An interview with Dr Max Pemberton

Diabetes – Treatment , Complication and Prevention of Diabetes – An interview with Dr Max Pemberton

A few weeks ago we were delighted to be able to interview Dr Max Pemberton about the key questions many of us has about diabetes.




We covered one of these topics in a post a few days ago because we felt that the definition of type 1 , type 2, type 3 and type 1.5 (as well as gestational diabetes and pre-diabetes)  was important enough to cover in its own post. You can check it out here.

Today we want to look at the treatments and complication of diabetes. So we lined up Max for a few more questions.

Diabetes Treatments

Patient Talk:- What are the treatments available for diabetes?

Max Pemberton:- So in recent years there’s been loads of developments in the way that we manage diabetes. As well as making key lifestyle changes, people with both Type 1 and Type 2 diabetes often need additional treatments such as medication like insulin to control their diabetes as well as things like their blood pressure and their blood fats so that’s their cholesterol.

Complications of Diabetes

Patient Talk:- Would you be able to elaborate on some of the complications of diabetes?

Max Pemberton:- So this is really important and this is why we take blood glucose levels so seriously is because if particularly, people have high blood glucose levels over long periods of time, it can cause really serious physical health complications and they include things like damage to blood vessels so that people are at increased risk of strokes and heart attacks. It can also cause damage to the very fine delicate blood vessels so that can cause problems with people’s kidneys. It can also cause problems with people’s eyesight so a condition called diabetic retinopathy whereby the delicate blood vessels at the back of the eye have problems and it can result in blindness. In fact it’s the leading cause of blindness in the UK. It can also develop things to do with circulation in the legs, for example where people can develop ulcers and in really extreme circumstances the circulation is so bad that people actually have to have their legs amputated.




Diabetic retinopathy and Diabetic foot ulcers

Patient Talk:- Explain what diabetic retinopathy and diabetic ulcers are?

Max Pemberton:- Diabetic retinopathy as I say it’s the leading cause of blindness in the UK so it’s so important that people get checked for this. On the NHS, everybody with a diagnosis of diabetes is entitled to free eye checks and I cannot emphasise enough the importance of going regularly to the optician to get your eyesight checked and make sure that this isn’t happening. If it is happening there’s tweaks and changes that can happen to your medication. Better blood glucose control can help it and various other procedures that doctors can do but it really is absolutely key that people are getting this monitored and also the same with the diabetic ulcers – so foot ulcers where the skin breaks down and forms an open sore and because of the difficulties of circulation they can take a really long time to heal. Sometimes they can be started by very small, tiny cuts or relatively insignificant wounds and one of the problems with diabetes is that some of the change that happens to circulation can also affect the very fine delicate nerves that are in the bottom of the feet so that often people can have damage to their feet – they stand on a drawing pin for example – and because the nerves in their feet aren’t working quite as well as they should do, they don’t actually feel it, they don’t realise that they’ve caused any damage and then that over time can develop into an ulcer. So again that’s why it’s really important that people with a diagnosis of diabetes go regularly to the chiropodist or podiatrist and they are entitled to free foot care on the NHS.

Prevention of Diabetes

Patient Talk:- In terms of lifestyle, what can be done to prevent diabetes? Are there any suggestions or advice?

Max Pemberton:- So there’s a whole range of lifestyle changes that can be made. So losing weight is really important, doing regular exercise, and also if you know family members who have a diagnosis of diabetes already it is important that you go regularly to the doctor to see whether or not you need to get checked to see if you’ve got diabetes. It’s not always obvious when somebody first develops it. The kind of typical presentation, things like feeling thirsty or tired or weight loss, they only happen to about half of patients, the other half have diabetes and they’re not aware of it and it’s picked up on routine screening. If people want more information there’s a website that’s being setup specifically to help people understand this delicate balance that has to take place when you have diabetes between the high blood glucose and the low blood glucose levels and that website is www.diabeteshighsandlows.co.uk

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Age-Related Macular Degeneration and Low Vision Awareness Month – Eat your Greens


Kai-lan or Chinese broccoli

Kai-lan or Chinese broccoli

Yep that’s it! Our contribution to Age-Related Macular Degeneration and Low Vision Awareness Month.

Eat your greens.( Yes I know it is a bit of an odd picture for a post on vision loss but I wanted to attract your attention to the importance of diet).

It seems that eating more green leafy vegetables can help with age related Age-Related Macular Degeneration (AMD). It can help slow the progression of dry AMD and help prevent wet AMD according to the UK’s National Health Service.

So what actually is AMD apart from being the most common cause of vision loss in the over 50s? Last year PatientTalk.Org created a “user guide” for macular degeneration. We did this by interviewing Victoria O’Connor and Cathy Yelf (from the Macular Society). O’Connor was representing Boots the Opticians.

You can read the guide here!

So what is the point of this blog apart from raising awareness of AMD? Well quite simple. One of the barriers to actually eating more greens is that on their own they can be a bit boring.

So I’m asking my readers to share their favorite green leafy vegetable recipes in the comments section below. (If you run a food blog or site a link would be grand!)


So in the aid of full transparency (well you know what I mean) let me kick off with one of my favorites. If memory serves I found it originally in the Australian Women’s Weekly but it has been adapted a bit since then.

Baby Spinach Pesto

Makes loads

You need:-

1lb or 450g of baby spinach
2oz or 50g pecan nuts (or really any you like)
Olive oil (say two glugs)
2oz or 50 Pecorino cheese or any hard cheese such as Parmesan. Indeed there are some good vegan option these days.
Two closes of garlic crushed
Juice of a lemons

To prepare? Please the lot in your blender and wizz till you get the consistency you like. You might want to add the nuts during rather than the beginning to the wizzing.

Eat with pasta of on top of a baked eggplant or aubergine!

PS The picture above of Kai-lan or Chinese broccoli. I picked some up in Chinatown in london yesterday. Great steamed with oyster sauce!

PPS Can I also mention that green vegetables could assist with Diabetic retiopathy on Optic Neuritis which is an early symtom of multiple sclerosis.

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Diabetic Eye Disease Month – Check out this brilliant infographic about Diabetic Retinopathy


Diabetic Eye Disease - Diabetic Retinopathy

Diabetic Eye Disease – Diabetic Retinopathy

As many of you will know one of the most serious complications of diabetes is diabetic retinopathy. Diabetic retinopathy is also referred to as diabetic eye disease.

As this is Diabetic Eye Disease Month we are delighted to share this infographic about Diabetic retinopathy from the National Eye Institute’s National Eye Health Education Program. You can find out more about its work here.