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[00:00:30] Speaker B: Program was pre recorded and the views expressed do not necessarily represent those of this station or its management.
[00:00:36] Speaker C: This is Open your eyes radio with Dr. Kerry Gelb. Good morning, I'm Dr. Kerry Gelb and welcome to Wellness 1280 on Open youn Eyes Radio. Please listen as I discuss the newest information in the world of health, nutrition and sports every Saturday morning, 6am Central Time on AM 1280 the Patriot. Also, please share your thoughts by emailing
[email protected] that's D R K E R R Y G e l b gmail.com and visit my new website, wellness1280.com where we have all guest links, wellness 1280 info and previous shows. Wellness is taking over the Patriot Airways for the next hour. Sit back and enjoy my interview with Dr. Sydney Sheket. Diabetes is the leading cause of blindness in people under the age of 55. Alarming statistics show that nearly 16% of American adults, or about 1 in 6, are living with diabetes today. Approximately 25% experience diabetic retinopathy, a serious eye condition that can lead to vision loss. The likelihood of ocular complications increases with duration and severity of the disease, making making awareness and early intervention absolutely critical to shed light on the latest treatments for diabetic eye disease. We're thrilled to welcome Dr. Sydney Shecket, or SID for short. A highly respected retina specialist from Maryland. Dr. Shecket has published extensively in leading journals like Retina and contributed to essential ophthalmology textbooks such as Ryan's Retina. Beyond his research, he has been recognized for its innovative surgical techniques that have transformed patient care. Dr. Shecket, thank you for joining me today on Open youn Eyes Radio and podcast with Dr. Kerry Gelb.
[00:02:39] Speaker B: Dr. Gelb, thanks so much for having me. I'm very excited for our talk today.
[00:02:43] Speaker C: I have to say I love your background. Can you explain to the audience what that is?
[00:02:49] Speaker B: Only since you asked, but I'm very proud of this background and I hope no one finds anything pathologic in it. But this is actually a picture of my retina this is a wide field fundus color fundus photo of my left retina. And that white circle is my optic nerve. So hopefully I have a brain in there somewhere behind it. And those red lines are the only place in the entire body where one could actually see live blood vessels without anything covering it like skin.
The macula is right over here, that little pigmented part. And we hear a lot about diseases over there. So that's what I see every day in my patients.
[00:03:35] Speaker C: Well, you know, I love it. Today we're going to talk a lot about diabetes. But how does looking at the capillaries of somebody's eye tell us about their health? Whether it's cardiovascular disease or if they have diabetes or they have high blood pressure? How does it help us?
[00:03:52] Speaker B: It is crucial. I, I know you went a lot into this in your awesome movie, but the eye really is the window to the soul for many reasons. And you know, there's a lot of specialists for different parts of the eye. I humbly propose that the retina is the most important part. It's like the film of the camera, but it tells you a lot about the entire body. Just by looking at a picture, we can often tell if someone has or hopefully we can rule out very serious diseases of all types from diabetes, high blood pressure.
Once in a while I see people who are literally minutes or hours away from having a stroke and send them to the er and we prevent death or terrible problems.
Leukemia, genetic diseases, you name it. But just by looking at the retina very often we can tell a lot about what's going on much, much further beyond the actual eye.
[00:04:53] Speaker C: The incidence of diabetes has been, is up about 60% since 2000, since the year 2000. So now we have about 41 million people, 41 million Americans that have diabetes. What do you think from somebody that's into health and nutrition like yourself? The main drivers of the increase in diabetes, not only in the United States, but in the rest of the Western world and the east, which is becoming more like the West.
[00:05:22] Speaker B: I am on a daily basis overwhelmed with, with how prevalent and how serious of a disease diabetes is in the various types, type 1, type 2 and others.
It's just incredible how busy my clinic often gets. And that's not planned. It's a lot of frequent add on emergency patients who are sent in with new blinding diabetic retinopathy diseases.
It's just always a little humbling to see how prevalent this disease is and how many serious issues it causes.
[00:06:06] Speaker C: You know, obesity plays a big role in this about 25% of people who are obese, obese adults have type 2 diabetes. People that are overworked, it goes down to about 12% and about 6% of people that are just normal weight, or maybe they're fat inside but skinny outside. We call them the skinny fat people have diet, have diabetes. And Dr. Lustig, who I've interviewed, talked about why not all people with obesity have diabetes. And they talk, talk about the difference between visceral fat and subcutaneous fat and that people with visceral fat have more inflammation and have greater risk of insulin resistance. And I was wondering if it's something that, you know, as a retina specialist, you're really dealing with people when the wheels have fallen off the bus. Myself, I'm primary care. I'm trying to prevent them from the wheels from falling off the bus. But have you thought about that, the obesity epidemic and how it drives diabetes all the time?
[00:07:09] Speaker B: Well, taking a step back, whenever I meet a new patient with diabetic retinopathy, and when they're referred to me from the primary eye docs like you, it means something very serious is already happening. So the best. I always say, I wish you never had to meet me. I wish you never had to have been referred to me for your severe retinopathy. And, you know, I don't mean that in a mean way. I mean, I wish they were able to have prevented getting this far along. And it's never. My other typical spiel is this is one of the most difficult diseases out there. And I always, I always say to the patients, once I tell them, you know, the retinopathy is from, you know, the poor diabetic control, the overweight and other risk factors. I always say there is no finger pointing here. It's, it's. You can be trying your best and struggling to have control over the weight or the sugars or the blood pressure, because there's a lot of other things that are thrown at you, like the genetic side of it or, you know, things that happen in childhood. So there's never finger pointing, but putting in the effort is, is paramount to helping prevent serious consequences of the diabetes. And, and obesity is a major part of it.
[00:08:33] Speaker C: You know, looking at the background, I mean, things have gotten so crazy that 93% of Americans are not metabolically healthy, you know, which means that their blood pressure is a little bit high or high, or their blood sugar is a little bit higher, or they have the big. They have the big belly. Their triglycerides are high. They may have not. They may have some cardiovascular disease. So asking you to put on your internal medicine had a little bit before you became a retina specialist.
This is something that is really concerning because of 93% of Americans aren't metabolically healthy. They're all at risk of winding up in your office and needing treatment by you.
[00:09:20] Speaker B: Yeah, it's a staggering amount of people. And I should have mentioned before, there's even some studies, small studies, but very interesting in that when someone, for instance, has severe diabetes that's causing severe retinopathy, and they come to see me when it's safe to watch it and observe it closely in case it gets much worse.
You know, it's a lot easier to say, try your best controlling the sugars.
You know that that takes time and a lot of effort, and it's almost insurmountable sometimes. But another thing I always say is try to lose weight. There are studies that show having the level of retinopathy that I see right now. If you were to lose 10 pounds, 15 pounds, you know, nothing crazy like 100 pounds.
[00:10:11] Speaker C: I'm speaking with Dr. Sydney Sheckett, retina specialist out of Maryland, Rosedale, Maryland, with the Elman Medical Group. He has a YouTube channel, Dr. Sydney Shekit, if you want to see some of his incredible surgeries. We'll be right back after the break. This is Dr. Kerry Gibson.
We are back with Dr. Sydney Sheckett, Elman Retina Group, Rosedale, Maryland. He specializes in surgical and medical care of the retina and the vitreous. We're talking about the eye, we're talking about the retina, we're talking about diabetes. And before the break, we were speaking about how many people are at risk for having diabetes or actually have it. It's an incredible amount, you know, and you were talking about losing weight. And, you know, we have to increase lifestyle, improve nutrition, physical and physical activity, and stress. But let's get back to the eye. About 25%, maybe a little bit more, of people with diabetes have diabetic retinopathy or changes from the diabetes. Tell us what diabetic retinopathy is and bring us through it in a. In a simple way. Where does it start to? Where? How does it end if it's not being taken care of?
[00:11:31] Speaker B: All right, how many hours you got?
It is very, very complex. And in the. In the clinics, no matter what doc you see, from the primary care doctor to the retina specialist, the clinical setting is with. No matter how much time the doctor has, the clinical setting is not enough to really explain everything about diabetic retinopathy. So patients I think should do their due diligence, do their homework and read more into it than what they're just getting in the clinic.
My preamble for every new patient, not, you know, every new patient I see of all diseases is no one can feel the retina. And that's a very, very important thing that non eye doctors don't realize is that it's not something you can feel like when you get a boo boo on your skin like my kids have every hour, every day, you feel it, you see it, you go see the doctor.
With diabetic retinopathy it's not, you can't feel any of the disease starting or if it's getting worse, no matter how bad it is. Usually when people feel stuff, it's the front of the eye being dry or scratched, the retina is all the way on the inside. And the disease, the retinopathy starts very mild and that's when you want to catch it. But if someone was going to be able to tell that the retinopathy is getting bad, that usually means it's already at the end stage. Unfortunately, usually they don't realize until the entire eye is filled with blood and that's too late. So it's imperative for diabetics to get a dilated eye exam every year to be checked for this.
Now there's diabetic retinopathy in the simplified version is actually various things. I like to lump it into two groups. Diabetic retinopathy is more specifically the bleeding aspect of the disease. But there's also another big one called diabetic macular edema or swelling in the macula.
And you can have in both eyes, it could be different levels of one or the other or both, or there's a lot of levels within each category. Retinopathy, there's mild, moderate, severe, and with diabetic macular edema also there's different types. And that's important because for various levels you could watch the patient. You can watch the patient and give them the pep talk to try to get their sugar and lifestyle under control.
But the goal is to always catch these things early so you can step in before there's permanent vision loss, permanent damage, as if, as in the eye filling up with blood and being irreparable.
[00:14:16] Speaker C: And many times the primary eye care doctor like myself, you know, you're the specialist that we refer to, we find hemorrhages and people have no idea that they're diabetic because a quarter of the people out there that don't know that they're diabetic. So many times we'll find hemorrhages or little microaneurysms and people that are pre diabetic and you know, a pre diabetic diabetes. And diabetes, it's just kind of an arbitrary term where they decide that diabetes is, you know, fasting blood sugar over 125, hemoglobin A1C over 6.4. You know, it's a bunch of very smart people getting in the room and deciding where they're going to place where somebody becomes diabetic. And that kind of is a moving target. Hasn't moved for a number of years, but it, it does move. So even if you're pre diabetic, you're at risk for retinal hemorrhages and different problems in the eye. Now, I want to talk about risk factors for diabetes. So let's talk about risk factors. First, I'd like to talk about how many people really that have diabetes really have good glycemic control. And statistics Show it's about 30% or good control of their blood pressure. Somewhere around 50% only have good control of their blood pressure. And studies have shown that if you have good control of your blood pressure, you could decrease the risk of having diabetic retinopathy progression by about 34%. So if you could go into some of the other risk factors like triglycerides, microalbumin, et cetera, that you're looking at, which risk factors are you worried about for progression?
[00:15:59] Speaker B: All right, first, just to touch on, you have no idea how many times I have a patient referred to me with retinopathy who is angry at the refer at their primary eye doc because they, you know, they're coming here for a second opinion, actually, because I don't trust that there's retinopathy. Remember, they can't feel this and they are adamant that they have pre diabetes. Pre diabetes, Nope. I go in there and I confirm with the great thorough eye doctor that caught this and I show the patient the pictures and I tell them I don't know how to define it overall, whether you need to start medications or not, I'm going to leave that to your primary care doctor and you. But I see retinopathy and often that's it's not just how things have been. You might have had good or decent sugar control, but often it's a harbinger of what's to come. So prediabetes still need to be examined and monitored because you never know for the Risk factors. That's one of the reasons I tell every patient that diabetes is one of the most difficult diseases to control because it's not just black and white glucose or sugar level control.
I often see patients with terrible, severe, worsening retinopathy. No matter what I throw at it. And they are saying, and I see it in their labs, that the sugars are very well controlled. A1C is good. It's never been better, doc, I always hear, but I ask, okay, how about your blood pressure? And then they, I see them lean back and say, well, that I'm still working on the salt and this and that. Or what about the cholesterol? I still love going to Dunkin Donuts every day. Or, you know, all of the, you have to have near perfect control of the all diseases in your body. Inflammation, cholesterol, anemia.
You know, overall health is also paramount for controlling this disease.
[00:17:59] Speaker C: No, it's interesting. Also, pregnancy, there's an increased risk of diabetic retinopathy. Anemia, increased risk of diabetic retinopathy. So let's talk about some of the tests that you do. You know, I'm examining the patient. I, you know, we, there are certain tests we do in our office, certain tests that you do. And as a retina specialist, one of the hallmarks of the test that retina specialists do is a fluorescein angiogram. Explain what that is. And are we still doing as many now with OCT or not doing as many fluorescein angiograms?
[00:18:33] Speaker B: Okay, this. Well, before that, I just wanted to say, not a shameless plug. I wrote the chapter on pregnancy related diabetic retinopathy or pregnancy related retina disease and retinopathy was the biggest chunk, overwhelming chunk of that chapter.
I think it's very important for diabetics who are considering or starting to think about getting pregnant. They should definitely have their eyes thoroughly examined before that because sometimes, you know, there's bad surprises that we would need to fix before they get pregnant. So very important thing, imaging of the retina in general is where I geek out and my assistants in the clinic or when I'm lecturing to the trainees, they often have to stop me rambling. So Dr. Gel, just feel free to.
The imaging from every aspect of the eye is beautiful. And the retina I think is the most beautiful. Now the best is when you see these images with a good healthy retina, no disease.
But often you need a lot more than just seeing the retina or taking regular color photo images.
You can look, I even As a retina specialist can look at a retina or look at a picture, a live picture of a retina and it can look not that bad. Maybe there's mild retinopathy, a few bleeding spots. Nothing bad, just would need to be watched. No, no significant looming risk for blinding blindness. Now we can't just rely on that. So at a retina appointment, anybody listening who's been to a retina doctor knows we always need to dilate the eyes. So that's first. You're not just going to go to the retina doc and get seen right away, in and out. We have to dilate. It's the only way to see the retina. And we often do several imaging modalities. We take pictures of the retina from different aspects because it's not just what we see as the examiner, it's also the function. Those blood vessels might look good, but is it flowing well? Is there any issues with the flow and fluorescein angiography? Just like angiography with CAT scan or mri, when you look at the blood vessels of the brain or the neck or the heart, fluorescein angiography of the retina is very similar. You inject a little dye and you take live pictures every second. You see the dye going from the arm to the retina and then it perfuses the retina within seconds. Even that bit of data is vital. But also ultimately, as all the dye goes through, we're often surprised at the severity of the disease that we see when compared to just looking at the retina itself. So fluorescent angiography is paramount for monitoring diabetic retinopathy?
[00:21:27] Speaker C: No. That's fantastic. And I know now most optometrists when they go into for primary care, we take digital retinal photos because now some of the cameras are so good we could see about 8 microns, which is better than we could see with an ophthalmoscope. And sometimes we could pick up things that we wouldn't be able to see without the picture. So the photograph is really important to have a photograph when you come into the eye doctor's office, even primary care. Is that something you would agree with?
[00:21:59] Speaker B: You know, even in the US where we have top notch health care, we have specialists of all types.
It's stagger.
Sorry. It's confusing to me and sad that there are still a significant amount of diabetics out there.
[00:22:17] Speaker C: Hold that thought. We'll be right back after the break. This is Dr. Kerry gel for open your eyes radio speaking with retina specialist Dr. Sydney Shecker.
We're back with Dr. Sydney Shekin, retina specialist at Maryland, Rosedale, Maryland, the Elman Retina Group. If you want to see Dr. Shecket, you can find them online. He also has a YouTube channel where he does teaches about surgery and what to expect. It's Dr. Sydney Sheckett. It's S C H E C H E T. Go to his YouTube channel.
It took me a long time to be able to pronounce his last name, but we're getting it. So, Dr. Shuckett, we were talking about routine patient going in for a routine exam, making retinal imaging as part of that exam and about some of the amazing things that will pick up, different hemorrhages and different problems that will pick up that not only to be able to save their eye, but also to save their life. And I was wondering your opinion as a retina specialist about doing imaging once a year or so to make sure that your blood vessels, it's a way to see the blood vessels at about 8 to 10 microns.
[00:23:32] Speaker B: Yeah, I think it's sad and shocking that in our great country with top notch health care specialists of all types, hospital systems, private practice, you name it, it's shocking that there are still a significant amount of diabetics who are not getting their yearly dilated eye exam check being done. And there's various reasons for that and sometimes it's access to care, whether wherever you live there's not enough retina doctors or the next available is way too long and or they go to the primary care doctor or endocrinologist, you know, for all the diabetic checkup. And then the doc says, I got to refer you to get your eye exam done. And then for whatever reason the patient doesn't follow up on that. And then next thing you know, it's the following year, the next appointment and the primary care doc says, nope, what's going on here? You didn't, you didn't get your eye exam? Well, to help combat that, there's this burgeoning new field of telemedicine, as a lot of us have seen during the pandemic. But in this case, you can't just zoom and look at someone's eye through the computer. So what, what there is, and it's great and hopefully this really helps many out there who are not getting their eye care. But you can get your eye imaged or you can get a picture of your retina at the primary care doctor or endocrinologist. You don't need to be dilated for some of them, one picture and that helps screen and that helps discover if there's a looming severe time sensitive threat or not. So I think that'll help a lot of people and hopefully decrease the amount of bad retinopathy out there.
[00:25:19] Speaker C: Yeah, and you're referring optometrists, you know, they're doing it routinely and so you want to make sure you get your, your eyes checked. Let's move on to something that I know you're very passionate about. OCT and OCT angiography, if you could explain that, why is that helpful to us?
[00:25:35] Speaker B: Well, they're very similar to what I've discovered that when I just discussed with the fluorescein angiography, looking at the function, looking at the retina at face value, just with the lights, you can miss a lot of things in terms of function. Well, technology has advanced so much that we now have like a three second scan of your macula, the center of the retina where you can get macular edema or swelling. And while again you can look with your eyes, even the best retina doc there could be very, very important but subtle findings of areas of swelling or abnormal blood vessels in the MA macula. And you might look at it and say, oh, you look good, I'll see you next year. But if you were to do an oct, a scan to the micrometer level, thinner than paper, where you can see the different levels of the macula, you might catch something very important that you need to treat to prevent the problem or you might want to just watch them closer. So oct, as most patients who've seen a retin doc or even any other eye docs, many, many eye clinics now have OCTs. It's a great screening tool for a lot of dise and one of the most notably being diabetic macular edema, the swelling. This is also important for a very common disease called macular degeneration. Octa OCT angiography is this new, exciting, I can talk about this for days. It's a new type of imaging modality that's an advancement to the OCT where it's not just showing you the layers of the macula, the structure, the architecture, it also shows you the various levels of the microscopic capillary blood vessels. And you can see literally where, where is the problem coming from in the blood vessels, where's the swelling coming from, where's the abnormal microaneurysm or blood vessel out pouching? And more than that, it also can help you. You can have a perfect looking retina and no diabetic macular edema, no Swelling and the patient doesn't see well. And by doing OCT angiography, you can see that while there might not be current active disease, there is permanent damage, permanent loss to some of the areas of blood flow. That's called ischemia or nonperfusion, where maybe the disease was active before and now it's not, but it left damage and that explains permanent vision loss. So it's very helpful for many reasons.
[00:28:04] Speaker C: Yeah, I mean, it's great. I mean, we do it in our office and we can see the capillary dropout around the macula. So we know that this is something that we would not be able to see in the past before we had OCT angiography. So in primary care optometry, I guess with fluorescein, you would. But not with OCT angiography, not with regular OCT angiography.
[00:28:28] Speaker B: You don't need to inject the dye, which is a big plus. And also, I don't know if you brought this up before on your shows, but definitely an interesting topic to just consider for the future is OCT angiography. Octa is very, very exciting for not just eye doctors, but also neurologists, geriatricians, because somehow this brilliant, beautiful imaging technology is. We're finding that we're able to potentially discover and diagnose Parkinson's and Alzheimer's at a very, very early stage, where often it's very difficult to diagnose.
[00:29:09] Speaker C: Yeah. Because when we're looking at the retina, we're really looking at the brain. So these blood vessels are dropping out in the retina, they're dropping out in the brain as well. So, I mean, so let's go and talk about how often people should get their eyes examined. We talked about before that. 97, 93%. And only 7% of the population is metabolically healthy. So only 7% of the population is metabolic healthy. So 93% are at risk for diabetes. So the average person out there, how often should they get their eyes examined?
[00:29:41] Speaker B: You know, you see some guidelines here and there, and depending what doctor you ask, you'll hear different answers. To me, my answer is, forget it. Forget if you're diabetic or not. Every human on earth should be seeing their. Their optometrist, their eye doctor, at least once a year for a checkup, even if it's boring. And you hear that every year looks good. See you next year. God willing, it's boring for all your medical visits.
So every person should get. Because you never know. I just saw. I was referred someone, she's 20, 20, went in to get glasses and the doctor caught a melanoma growing in her retina. She couldn't feel it, and it wasn't that big yet. But imagine if she didn't get her eye checked, how bad that could have gotten. So diabetics definitely need a yearly eye exam. And that should be including the retina check, whether it's dilated or undilated with some technology.
Because if there is anything brewing, even mild retinopathy or moderate retinopathy that you don't need to treat, you need to be watched much more closely because the risk goes higher of progression. So yearly dilated eye exams are paramount. And if there's anything found, then it's going to be more frequent than that. In fact, at the first several months of the pandemic, all the elective medical offices were closed. And that could have been from March at least till May or June as a retina doc that summer, six months in, seven months into the pandemic, that summer was the busiest summer of my life. All the patients started coming out of the house, getting their regular eye exam and thinking they might need glasses because things got worse. And next thing you know, they have severe emergent diabetic retinopathy where every second counts. And we were getting flooded with that every day, every night, all weekend for that summer. If only people would have gotten their checkups, we could have prevented a lot of those disasters.
[00:31:42] Speaker C: I think something also interesting that we see with OCT is that is retinal diabetic neuropathy, where the inner retina is thinner and those people that have, that are at increased risk of stroke, heart attack, heart failure, and really all cause mentality. And these are something that we wouldn't see before we had oct. Now, let's talk about treatment a little bit. Let's talk about macular edema. Let's talk about the treatment of that. And when do you treat? When? And what are the different treatments?
[00:32:14] Speaker B: All right, so again, this could take hours to explain, but the brief and simplified version is, you know, let's say your past, you were, you saw your eye doctor. Retinopathy or macular edema. Remember the two types something it was caught, you get referred to the retina doc. We have so much data, and it's always the research is growing and kind of taking turns this way and that way. So even what we learned five years ago is outdated today.
It's first important for us to stage and grade the level of retinopathy or macular edema. So with retinopathy, there's two categories, non proliferative and proliferative. Non proliferative is not proliferating. The bleeding isn't getting worse by the second or oozing into the eye. You have mild non proliferative where there's a few blood spots or microaneurysms. Then there's moderate non proliferative where there's a little more. Then you get to severe non proliferative where there's actual changes of the blood vessels like venous beating you might read about or other micro vascular changes. And as you get more non proliferative, your risk of converting to proliferative, where there's active disease that is going to make you blind, the risk goes higher. So someone with moderate non proliferative, we don't need a treat other than general health modifications. But I would watch much closer, maybe every six months or so when they start getting proliferative. There's actual abnormal blood vessels that are leaking blood and filling up the eye. That's when we start the treatments.
Then there's macular edema or swelling. And that is separate than retinopathy, where you can have severe swelling or mild swelling. It can be in the center of your macula or on the sides. And depending on the scenario, we would decide whether to treat.
[00:34:16] Speaker C: Hold that thought. We're up against the break. This is Dr. Kerry Delver. Open your eyes. Radio we'll be back with Dr. Sid Sheckett, retina specialist, in just a moment.
We're back with Dr. Sydney Sheckett, ophthalmologist, retina specialist. And we were talking about treatments and we was just finishing up on macular edema.
[00:34:42] Speaker B: So I just briefly reviewed the difference between retinopathy, macular edema and the different levels. And that's important not just for how often one should be examined and watched, but also to determine what's the best treatment option. And now, very commonly, when, you know, when, Dr. Gelb, when you would diagnose a patient with new retinopathy and refer them to me across the country and then the patient, you know, gets a second opinion with Dr. Google and they go on Google and they see diabetic retinopathy treatment and they see pictures or read horror stories about injections in the eyeball or laser surgeries and often that scares them away. They don't even show up until it's too severe. Well, you don't consult with Dr. Google when you come to the retina, doc. We stage it, we figure it out. And often it could be the treatments could be anywhere from watching closely with your regular eye doctor and with the retina doc. So everybody's watching you anywhere from that to something very intense like surgery. But there's a lot of in between.
Sometimes, depending on the scenario, we could just watch it closely or prescribe different types of eye drops for more mild issues. Sometimes it could be a laser procedure that's not surgical. There's different types of laser, and often they don't hurt or have any side effects. So they're minimally invasive. And then you get into the more invasive options like intraocular or intravitreal injections, where you're literally sticking a needle in the eye right in the clinic. It's not surgery. It just needs some topical numbing.
And we inject medicine in the eye now. It's not usually a one and done like a vaccine. It's usually injections indefinitely. And they usually start monthly until you get control and then every other month. And it takes years to get off the injections. And there's different types of injections, different plans with that. And all of this is to prevent permanent blindness, which was a very high risk before these treatments.
Now with the treatments, while they're not fun and they're difficult and they have their risks and they're invasive, the risk of blindness has dramatically been reduced. And that's the ultimate goal. No matter what we need to do is to prevent you from going permanently blind.
[00:37:19] Speaker C: And of the different injections, we call them anti VEGF injection injections, there's all these new ones, you know, the old ones we've been using Lucentis, a Bastin, and then little newer Ilia. And now Ribismo is on television every five minutes is. I know that from your point of view, unfortunately, you have to deal with patients insurance, which ones they'll cover, which ones they won't cover. Well, otherwise it may get too expensive. Is there a big difference in the anti VEGF injection, the medications?
[00:37:54] Speaker B: Yeah. So anti VEGF injections are a miraculous advancement in all of medicine in the past few decades. And before that was available 15, 20 years ago, there was not much. There was nothing as effective as these injections. And there's different generations. Anti VEGF is the class like nsaid, painkillers like ibuprofen and Aleve. So same with anti vegf. It's one major class that works for diabetic retinopathy and macular edema. And within that class, there's the first generation, the second generation, third generation, and depending on the scenario, any will work or only one might work or it might be too late. Even so, that's why we got to watch closely. There's a lot of commercials now because there is a lot of advancements starting and further on the horizon. So maybe it's a good thing that all the pharmaceutical companies are competing with each other. But it does bring a lot of patients, a lot of papers or questions about the commercial said this or said that. Nothing straightforward against the latest generations that are FDA approved, the Bismo and the competitor Ileah hd and they're all the same procedure and same overall goal. But there are minor differences depending on the scenario. Whoever's sitting on the chair, I, you.
[00:39:23] Speaker C: Know, I thought it was very interesting. You know, when you look at the Australian literature, they talk about phenofibrate and using that. This is an old medicine that's used for triglycerides a little bit for cholesterol. It's called Tricor and it lowers triglycerides, it lowers LDL a little bit, but it's been shown to decrease and prevent that macular edema and the really bad retinopathy, the proliferative diabetic retinopathy. In fact, the number needed to treat is 17 on some of the studies and it had a risk reduction of diabetic macular edema as high as 50% and a 27% reduction. And referring for advancement of diabetic retinopathy that needed treatment. Now, I know you've done some studies on this or you've looked into this. Tell me what you think about Tricor, a phenofibrate as something that may decrease the risk and is it something as a retina specialist that you would call their PCP and say to them, you may want to consider using this of the patient's triglycerides are high.
[00:40:34] Speaker B: Yes.
So, you know, as eye doctors, we, we are not just eye doctors. All of us have to know about the body and the diseases in the body and how they and the treatment options.
It's all intertwined and important to know about Phenofibrate, for reasons that are complex and also they're still unknown, has an effect on retinopathy and not just on the body, but on retinopathy specifically with maybe improving the retinopathy or preventing slowing down progression. We're involved in this awesome international clinical research consortium called the drcr and there's a lot of trials that they do and a lot of them are landmark. And we're involved in drcraf, the phenofibrate study, where we're not only assessing if phenofibrate is an option, a valid option that actually works.
We're also it's a side study of assessing and evaluating the communication between the eye doctor and the primary care endocrinologist. So it'll be very interesting to show how the communication is flowing between the doctors. It's not always so fluid and easy.
Currently when someone has non proliferative retinopathy, mild, moderate, it's not worth doing lasers or surgery or injections for that, that's too invasive for those stages. So currently just watch closely and I say you can do it. Get your sugars, blood pressure under control. See you next time. I wish there was something more I can do. There's no drop or easy pill to take currently for that. So this phenofibrate might be that option, something that we can do that's effective in the nonproliferative stages.
[00:42:22] Speaker C: And I just want to bring up some other studies out of Spain. The pre dimed study would show that using omega 3s could decrease the becoming diabetic and that 500mg of omega 3s this study was from seafood that there was a 50% less likely to get site threatening retinopathy.
So omega 3s may be helpful also ACE inhibitors for blood pressure. We talked about that a little bit how blood that could be helpful. So any comments about omega 3s and obviously you want to make sure your blood pressure is okay, but any comments about that?
[00:43:04] Speaker B: Yeah, these omega 3s or the Mediterranean diet that they generally have with seafood, rice, green leafy vegetables that there's extensive studies on how either the supplements or the actual diet alone has a significant impact on not just overall health and various cardiovascular disease, but it has a legitimate, a positive effect on retinopathy and other severe eye diseases like macular degeneration.
So that is also something that you can do and modify other than working hard on the sugars with your medications or exercises. Also what you eat. And it's very counterintuitive. It could be. I have diabetics who pound fruit. Oh yeah doc, I'm eating healthy. I'm eating oranges and this and that. Those have high sugars and sometimes a little not good for your overall diet. But definitely omega 3s. A Mediterranean diet can have a profound impact on not just your overall well being but on your retinopathy. I've seen it even improve the retinopathy more than any medication I injected into the eye.
[00:44:19] Speaker C: Yeah. And also macular pigment that we look at a diabetes lowers macular pigment. So we're, we're, we're about to finish. We have about 30 seconds left. People want to find out more about you. How could they do that?
[00:44:34] Speaker B: Well, you can always look me up online. My, my awesome practice. The Elman Retina Group has a really nice website. I have a YouTube channel that shows retina surgeries. And in a simplified but fun way, social media.
You can find me in Baltimore.
[00:44:54] Speaker C: Well, Dr. Sydney Sheckett. Sid. I want to thank you for joining me. You're a wealth of information and a really nice person. And thank you for helping my audience learn about diabetic eye disease. We'll see you next time. This is Dr. Kerri.
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