A Dose of Dr. E: A Peek and a Poke Inside My Eye Appointment

Retina Specialist Dr. Nikolas London of Retina Consultants in San Diego explains the risk factors, symptoms and treatment options for diabetic eye disease – specifically retinopathy and macular edema. He discusses which type of eye doctor you should see for your annual visits, why it’s important to get a dilated eye exam every year, and when you should consider seeing a retina specialist.

Additional Resources:

TCOYD Podcast Episode #10: Diabetes & Eye Health

  1. Ouch!!! Just watched Dr. E. injection……most interesting video re eye care. Thank You.
    I maintain my annual fully-dilated eye exam, pics, etc.

    Question please: Do you have referrals to Endocrinologists in Temecula/Murrieta area….or
    do you accept new patients? and who would I contact?? I am Type 1 over 58 years.

    Thank you for TCOYD.


    • Hello Barbara…congrats on your 58 years of having T1D. My clinic is pretty booked, but just try calling 858-657-1636 and ask to see any of the type 1 oriented folks. Dr. Pettus, Dr. Santos, Dr. McCowen, Dr. Choe, Dr. Woods – all excellent and I trained them all!

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    DR Edelman: I appreciate the continuing education that TCOYD provides to diabetics.
    You and TCOYD are a blessing to anyone wanting to be educated about diabetes. You are a hero in my book.

    Jim Nycum

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    Loved this. Very informative and great video.

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    VERY informative. Thanks. Can these injections work after cataract surgery?

    • Hi Liz – thank you! Yes, anti-VEGF injections are completely unaffected by cataract surgery. I would typically fully endorse cataract surgery for those who need it. In fact, having cataract surgery makes it safer to consider other injectable medications, such as corticosteroids, which otherwise could accelerate cataract formation. We do tend to watch patients who are receiving injections a bit more closely following cataract surgery, as they can occasionally have a transient increase in macular edema.

  5. Thank you for these instructional videos!!!!

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    This was perfect timing for me — I’m scheduled for my yearly retinal scan tomorrow !– As always this segment was great – very informative with you actually going through the procedures and injections yourself- hope you’ll continue to have healthy vision! thank you ! I miss the live events for med professionals for CME- always fun – as well as keeping us updated with the latest research- anything on the horizon for the latest in stem cell treatments? thx !

    • Hi Christine – Thanks so much for the comment and question. Stem cell research is a hot topic in Ophthalmology and Retinal diseases. At this point, the main area being looked at is for an advanced type of macular degeneration where a tissue layer beneath the retina has become severely damaged. While I don’t believe there are any major stem cell studies for diabetic eye disease, gene therapy is similarly cutting-edge, and very exciting. On a side note, be careful about stem cell studies as there are some dangerous therapies posing as legitimate research out there. Please always consult with your ophthalmologist or retina specialist for anything you are considering participating in!

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    Fantastic piece on your care and experience with retinopathy and macular edema. Excellent Edelman education as always. Miss you in person. Looking forward to return to conferences some day. In the meantime appreciate all the virtual efforts

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    Great video about eye treatments. Learned a lot about the eyes that I never knew. Have had diabetes T1, for 30 years, and have an annual eye exam once a year.

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    Good information on eye health! The injection was interesting too!

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    Thank you so much for the detailed information on the pathophysiology of retinopathy & macular edema and about the latest therapies. I am a CDE, and the information I learned will help me to educate my patients better!

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    I just started injections of Lucentis for both eyes. It’s working well, reducing one eye from a 6 to a 1. The other eye just received it for a 1. Do patients ever get scar tissue in the eye from the injections that prevents further injections?
    Is there any projected date for use of the gene therapy? Or other non-injection therapies?
    Thank you for all your continued diabetic education.

    • Hi Susie – Lucentis is a great medication and I’m glad to hear you are doing well. Thanks for the great question about scar tissue – we get asked this a lot. While patients can occasionally become resistant to one treatment modality (fortunately others are available), the development of scar tissue due to anti-VEGF treatment such as Lucentis is not a concern. As for gene therapy, this is in the works for diabetic retinopathy with clinical trials actively enrolling, and is likely in the development stage for diabetic macular edema. We are involved in the trials, and could provide more information if you would like.

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    Hello doctors, I watched this morning—October 29. I appreciated your video tremendously and have some questions. I was diagnosed with T1D 60 years ago and have had numerous treatments for retinopathy (controlled) and macular edema. For several years I got injections every 3 months for macular edema (Lucentis, Eylea and Ozurdex).

    I have now had my first injection of the medication supposed to last 2 years or more (Iluvien). My retina specialist is supposed to be the best in our area. I was the first person he injected with Iluvien (1 year ago June). And he isn’t as deft with injections as Dr. London. My injections are painful. Like others I have concerns that the longer-acting device for delivering steroids doesn’t dissolve. But although I resisted for a while, I said yes and am thrilled to avoid more frequent injections.

    It confused me that Dr. Edelman is getting monthly injections and there was no mention of the longer-acting version. What is Dr. London’s general recommendation? Any thoughts on Iluvien?

    • Dear Karen,
      Thanks so much for the comment, and I am really glad you enjoyed the video! Your comments and questions are important. First of all, sorry to hear your injections are (or were) painful. They certainly can be, but this can be minimized in a few ways. Pain can be from the injection itself, or from the betadine used for antisepsis. For the injection, this depends a bit on the physician’s technique. I like to use something called subconjunctival anesthesia (a small amount of lidocaine under the “skin” of the eye). I let this sit for a few minutes to numb the eye. I also do not use a lid speculum, which seems to help. You can ask your doctor about these. For the betadine, the best thing you can do is to make sure your eye is very well hydrated with artificial tears before your injection. The less betadine you can absorb into the tissue, the better. You can also ask the doctor to use as little as they are comfortable with, and to wash it away soon after the injection. Many patients still have discomfort, in which case judicious use of a prescription topical anti-inflammatory drop can help. As for Iluvien! Yes, it is a nice medication for a certain subset of patients. Most of us consider it a second-line agent, following the anti-VEGF injections given the higher side effect profile which includes cataract formation and possible eye pressure elevation, which could cause glaucoma. However, some patients do not fully improve with anti-VEGF injections alone. In these patients I like to use an Ozurdex to make sure they respond to a corticosteroid (Ozurdex lasts roughly 3 months). If they do, have no corticosteroid side effects, like the idea of less frequent injections, and their insurance is willing to cover the $8000.00 for Iluvien, it is a great option. Keep in mind that after being treated with Iluvien the expectation is not zero injections for 3 years, but certainly should be fewer with a booster here and there. Believe-it-or-not, we actually used this for Dr. Edelman, and that eye is doing wonderfully without injections for some time now!

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        Thank you so much for your comprehensive reply. My docs have been carefully following my eye pressure. And It helps to hear that I might need a booster. That possibility has come up and I wasn’t sure how to respond–thought maybe something had gone wrong. We are all such complex creatures. Blessings.

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    First off, thanks for your whole site! I’m finally getting my diabetes under control, and the information here has helped immeasurably!

    I recently had my first diabetic-related appointment with an opthalmologist, and she told me I had “cotton wool spots” on my retina, but didn’t seem too concerned. Is this caused by either of the conditions discussed in this video, and should I be demanding to see a more specialized eye doctor about it?

    • Cotton wool spots are nothing to panic over, but they are associated with diabetes abnormalities in the eye. Perhaps a retinologist would help put you at ease.

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