NIH-funded study shows less diabetic retinopathy progression among those who underwent intensive glycemic control

People with type 2 diabetes who intensively controlled their blood sugar level during the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial Eye Study were found to have cut their risk of diabetic retinopathy in half in a follow-up analysis conducted four years after stopping intensive therapy. Investigators who led the ACCORD Follow-on Eye Study (ACCORDION) announced the results today in New Orleans at the American Diabetes Association annual meeting. The study was supported by the National Institutes of Health’s National Eye Institute (NEI).

“This study sends a powerful message to people with type 2 diabetes who worry about losing vision,” said Emily Chew, M.D., deputy director of the NEI Division of Epidemiology and Clinical Applications and lead author of the study report, published online today in Diabetes Care. “Well-controlled glycemia, or blood sugar level, has a positive, measurable, and lasting effect on eye health.”

A complication of diabetes, diabetic retinopathy can damage tiny blood vessels in the retina—the light-sensitive tissue in the back of the eye. ACCORDION is a follow-up assessment of diabetic retinopathy progression in 1,310 people who participated in ACCORD, which tested three treatment strategies to reduce the risk of cardiovascular disease among people with longstanding type 2 diabetes. ACCORD tested maintaining near-normal blood sugar levels (intensive glycemic control); improving blood lipid levels, such as lowering LDL “bad” cholesterol and triglycerides and raising HDL “good” cholesterol; and lowering blood pressure.

The treatment phase of the glycemic control portion of ACCORD had been planned to last 5.6 years but was stopped at 3.5 years due to an increase in death among participants in the intensive glycemic control group. The blood pressure and blood lipid portions of ACCORD continued. Tight control successfully reduced glycemia to an average 6.4-percent A1C—a measure of average blood glucose—compared to 7.7 percent among participants on standard glycemic control therapy.

Although it failed to reduce cardiovascular disease risk, such as heart attack and stroke, the researchers found that the therapy had cut retinopathy progression by about one-third by the end of ACCORD. Investigators considered progression to have occurred if a participant required laser surgery for diabetic retinopathy, required a vitrectomy—a procedure used to remove the gel-like fluid of the eye—or advanced three or more steps on the Early Treatment Diabetic Retinopathy Study (ETDRS) Severity Scale. The ETDRS Severity Scale uses photographs of the retina to rate disease severity from 1 (no disease) to 17 (high-risk for progression in both eyes).

ACCORDION re-assessed diabetic retinopathy about four years after the intensive glycemic control portion of the study had ended—eight years after enrollment in ACCORD. By then, average A1C was nearly the same: 7.8 percent for the intensive therapy group and 7.9 percent for the standard therapy group. However, diabetic retinopathy had advanced in only 5.8 percent of participants in the intensive therapy group since enrollment in ACCORD, compared to 12.7 percent in the standard therapy group.

“Despite this equalization of glycemic control in the two groups, there continued to be an approximately 50-percent risk reduction of further retinopathy progression, a phenomenon termed metabolic memory,” said Frederick L. Ferris III, M.D., NEI clinical director, who was not involved in the study.

Other clinical trials have reported the phenomenon, also known as the legacy effect. Participants with type 1 diabetes who received intensive glycemic therapy in the 10-year-long Diabetes Control and Complications Trial on average had 50-percent less progression of diabetic retinopathy three decades later. A similar trend was seen in the United Kingdom Prospective Diabetes Project, a study of people with newly diagnosed type 2 diabetes.

Results from ACCORDION suggest that lowering blood glucose can reduce progression of retinal disease relatively late in the course of type 2 diabetes and that even short-term changes in glucose have an effect. The findings add to mounting evidence that tight glycemic control has positive, long-lasting effects on small blood vessels. Other follow-up studies of ACCORD participants have observed a legacy effect similar to ACCORDION in kidney and peripheral nerve health, which also involve small blood vessels. But the benefits of intensive glycemic therapy must be weighed against the potential risks—most notably the increased risk of death observed in ACCORD. Investigators have been unable to determine a cause for the increase, which was not seen in other trials.

Results also point to a possible role for ongoing use of fenofibrate to treat diabetic retinopathy, if taken regularly. The blood lipid and blood pressure portions of ACCORD concluded at 5.6 years. Neither strategies reduced cardiovascular disease. However, fenofibrate, a drug that raises HDL cholesterol, decreased diabetic retinopathy progression by about one-third during ACCORD. ACCORDION investigators found fenofibrate had no lasting benefit 3 years after the drug was discontinued.

But based on ACCORD findings, fenofibrate might be worth taking to control diabetic retinopathy progression. Other countries, including Australia, have approved fenofibrate for treating diabetic retinopathy but not the U.S., said Chew. The NEI-funded Diabetic Retinopathy Clinical Research Network is currently planning a clinical trial to further explore ongoing use of fenofibrate to control diabetic retinopathy.

Diabetic retinopathy affects about 7.7 million Americans and is the leading cause of vision loss among working-age Americans. Diabetic retinopathy can cause blood vessels to swell and leak fluid, sometimes distorting vision. Proliferative diabetic retinopathy, an advanced stage of the disease, occurs when abnormal blood vessels appear on the surface of the retina. These abnormal blood vessels are prone to bleeding and lead to the formation of scar tissue, sometimes causing retinal detachment and permanent vision loss.

The NEI provides information about diabetic retinopathy at http://www.nei.nih.gov/health/diabetic/.

View an NEI video about how diabetic retinopathy can be detected through a comprehensive dilated eye exam at http://youtu.be/sQ-0RkPu35o.

ACCORD was funded by the National Heart, Lung, and Blood Institute (NHLBI); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); and NEI.

ACCORDION was funded through NHLBI contract HHSN268201100027C.

The ACCORD Eye Study is registered as NCT00542178 at ClinicalTrials.gov.

References:

Chew, EY, et al. Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-on Study. Diabetes Care. 2016; 39:1-12. DOI: 10:2337/dc16-0024.

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Part of the National Institutes of Health, NHLBI plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov.

The NIDDK, a component of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, visit http://www.niddk.nih.gov.

NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit http://nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIH…Turning Discovery Into Health®

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Who is at risk for glaucoma?

Anyone can develop glaucoma! Those who are at highest risk and should have a dilated eye exam at least every one or two years include:

• African Americans over age 40
• Everyone over age 60
• People with a family history of glaucoma
• Individuals who have had a serious eye injury
• People with diabetes (Get a dilated eye exam every year)

Although a cure for glaucoma has not been found, early detection and treatment can usually preserve vision. Vision loss from glaucoma cannot be restored. It is important to become your own advocate. This can begin by signing up for a FREE POB glaucoma screening at one of the sites on the June glaucoma screening schedule.

View POB’s Calendar of Events for upcoming free glaucoma screenings.

Learn more about glaucoma.

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It has been said that technology has made the world smaller, but for people who are visually impaired, smart devices are opening up a whole new world.

The iPhone has become a great equalizer for people with vision loss. App accessibility is very empowering, for it opens doors for people with vision loss or other challenges to do things they would not otherwise be able to do.

Mark your calendar for POB’s Macular Degeneration Network meeting on Sunday, June 12, at Sibley Medical Building. Bring your devices, or bring someone who has one if you don’t, and join POB in this most enlightening and eye-opening event.

Learn more about this event.

 

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The American Academy of Ophthalmology (AAO) continues to caution that too much exposure to UV light raises the risk of eye diseases including cataracts, growths on the eyelids and cancers. Growths on the eyes can appear in the late teens and early 20s, especially for those who have spent long hours under the midday sun. Diseases like cataracts and eye cancers can take many years to develop.

If you are concerned about keeping your eyes safe from the sun, check the Calendar of Events for programs on June 14 at MedStar Washington Hospital Center and June 16 at Friendship Heights Village Center, which will feature eye health professionals, resource information and a light lunch.

Learn more about this event at MedStar Washington Hospital Center or at Friendship Heights Village Center.

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The Remarkable Retina

You are invited to a world-class presentation at the community eye health event with celebrated ophthalmologist and retinal specialist, Michael M. Lai, M.D., Ph.D.

Dr. Lai, a physician for adult and pediatric patients at Retina Group of Washington, will explore the vital role of the retina (the light-sensitive layer of nerve tissue lining the inner eye) and why it is a most integral part of how we see – plus what to do if our retina is damaged!

Bring your questions and concerns for the open Q&A, when low vision specialist Adriana Wiseman, O.D., will join Dr. Lai.

Prior to the presentation, there will be free vision screenings beginning at 11 a.m. provided by POB.

This event is co-sponsored by The Beacon Newspapers, JCCGW, Montgomery County Health & Human Services, POB and Shady Grove Adventist Hospital.

Learn more about this event.

 

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If you are newly diagnosed with low vision or have been on a circuitous search for guidance about living with your “new sight,” look no further.

The American Academy of Ophthalmology (AAO) is the professional medical association of ophthalmologists, and its membership includes more than 90 percent of practicing ophthalmologists in the United States as well as more than 7,000 members abroad. Its mission is “to ensure that the public can obtain the best possible eye care.”

To access low vision information, visit the AAO website, www.aao.org, and type “low vision” in the search bar.

Note: Some of the information may be outdated because of the fast pace of technology solutions. For best results, ask your eye doctor or his or her staff for help.

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Understanding Your New Sight

You’re invited to meet Lind Stevens, OTRL, SCLV, MS, a highly accomplished occupational therapist with a specialization in low vision rehabilitation, on Sunday, May 15, at the Macular Degeneration Network meeting at Sibley Medical Building.

This program is in response to the Town Hall meeting on March 19, when countless attendees expressed a resounding need for Medicare reimbursable services to cover low vision rehabilitation.

Lind and her colleagues hold the keys to many of the concerns expressed regarding the desire to stay engaged and live a full, happy and active life. You don’t need to have macular degeneration to attend this meeting – just a desire to learn about the sight we have rather than the sight we have lost.

Learn more about this event.

 

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The Prevention of Blindness Society of Metropolitan Washington® (POB) celebrated 80 years of providing sight-saving services in the DMV area on Saturday, March 19 at the Night of Vision® gala, which was held at Four Seasons Hotel Washington, D.C. POB honored five community members during the evening, and raised vital funds and awareness for the organization’s local vision programs.

Andrew Adelson, M.D., a local ophthalmic surgeon specializing in glaucoma and cataracts, received the 2016 Professional Service Award for his outstanding work in the field of vision care. In addition, POB presented the 2016 Community Service Award to Janet and Hal Morrison for their more than 25 years working with POB and the low vision community, and presented the 2016 Appreciation Award to Amy L. Bess and Sadina Montani of Vedder Price for their pro bono legal assistance to the organization.

NBC News4 Chief Meteorologist Doug Kammerer served as master of ceremonies for the event and warmed up the crowd despite the chilly weather outside.

The event’s theme, “Beyond the See,” combined oceanic décor, a “Diving for Pearls” opportunity drawing with stunning pearl prizes, and a 200-piece silent auction featuring items such as a behind-the-scenes tour of the NBC Studios in Washington, DC with Doug Kammerer and a private, after-hours tour of the MoMA for 10. Also included in the event was a live auction featuring: tickets to Live! with Kelly and Michael; a DC date night package with a stay at the Four Seasons; and a build-your-own dream vacation package with 50,000 AAdvantage Miles from American Airlines and a $500 Marriott gift card.

Guests of the gala had the opportunity to make a $100 donation to have their name added to a tile, which will become part of a beautiful mosaic in POB’s newly built headquarters on Capitol Hill. POB is set to move into its new headquarters in the coming months. The building provides improved accessibility, room for growth, a Low Vision Learning Center, and a community lecture hall for future vision research updates, eye health seminars and low vision support group meetings.

POB (formerly D.C. Society for the Prevention of Blindness) was founded on March 10, 1936 by May B. Vories and Dr. William H. Wilmer, founder of the Wilmer Eye Institute at Johns Hopkins, as a seven-point program to bring eye health information to the Washington, D.C. community.

Today, POB is the largest local prevention of blindness agency in the United States, dedicated to the improvement and preservation of sight by providing services, education, advocacy and innovation. The organization serves the District of Columbia, Montgomery and Prince George’s counties of Maryland, and Northern Virginia. POB screens more than 8,000 children annually for vision loss and strabismus, and thousands of adults for glaucoma. The organization provides thousands of low-income and homeless community members with eyeglasses each year, and helps those with low vision retain their independence through personalized rehabilitation programs at its Low Vision Learning Center. Its Aging Eye Network, Macular Degeneration Network and Stargardt’s Network provide public programs and support groups to the community.

For more information about POB or the Night of Vision gala, visit youreyes.org.

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The Smithsonian American Art Museum, in collaboration with POB, proudly introduces “America InSight,” a docent-led tour for visitors who are visually impaired.

Enjoy highlights of the art collection through rich verbal description and sensory discussions using printed copies of artwork and 3-D models visitors can touch and view up close. The tour is finished in time for participants to find a good seat and enjoy a live musical performance to complete the art experience.

To kick off this new program, learn from the experts of the American Art Museum by attending the Vision Support Lunch & Learn on April 21 at Friendship Heights Village Center at 12:30 p.m.

Learn more about this event.

 

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Eye Pain – the stabbing, throbbing, burning, gritty, sharp, aching, “something in my eye” feeling – can be very uncomfortable. Many people seek medical care when they have pain, and for good reason.

The meaning of the word pain is generally open for interpretation. Some people describe the pain as in their eyes, around their eyes, or behind their eyes. Learn about eye pain symptoms and what they could mean at the April 12 Low Vision Lunch and Learn at MedStar Washington Hospital Center. Space is limited.

Learn more about this event.

 

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