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Highlands Today

Eye Surgeon: Stricter Diabetes Standards Needed

Jasmina Meyer, Highlands Today

From left: Michael Ackerman prepares for Pan-Rental surgery as Dr.Rulx Ganthier, an ophthalmologist and retina specialist, makes adjustments before beginning the laser surgery recently in Sebring.

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By GARY PINNELL

Highlands Today

Published: November 17, 2008

SEBRING - Last month, Michael Ackerman was blind in one eye.

The simple reason why: he is diabetic.

Dr. Rulx Ganthier has the medical explanation: proliferative diabetic retinopathy and cystoid macular edema.

What happened to Ackerman, who allowed his operation to be photographed to illustrate this story, is that his diabetes slowed down the supply of blood to the eye. Other blood vessels sensed the need for more blood, grew out of control, and literally blinded his eye with blood.

That's what happens when diabetes gets out of control, said Gaunthier, a Sebring eye surgeon who also chairs the Diabetes Advisory Council. "Florida's governor-appointed Diabetes Advisory Council is mandated by statute to provide statewide leadership to improve the lives of Floridians with diabetes and reduce the burden of diabetes."

That's why the council has written a letter to Ana Viamonte Ros, Florida's Surgeon General, with two goals: improve access to diabetes self-management education, and increase the diagnosis of pre-diabetes, said Gaunthier, an ophthalmologist and retina specialist.

"Although insurance coverage of diabetes self-management education is mandated by Florida statutes, there is no language in the statutes or administrative rules to establish minimum standards," Gaunthier said. So the Diabetes Advisory Council wants the surgeon general to require HMOs and insurance companies to require American Diabetes Association standards in self-education.

For juvenile diabetics, that self-education starts when they are children. But it also imposes a special burden on them. In Duval County, Ganthier points out, the school district transfers diabetic students to schools with a full-time nurse.

In other counties, he said, parents must come to the schools to give insulin injections to their diabetic children, check blood glucose levels, and accompany their children on field trips and after-school events.

"These actions hamper children's access to school-related opportunities afforded to other children, and penalize children just because they have diabetes," said Gaunthier, who performs eye surgery in Keys Professional Plaza. "These policies violate federal laws, including the Americans with Disabilities Act."

It's not a big problem in Highlands County, said Sherry Koehler Harter, the district health resource teacher.

Each school has a health aide, said Harter, a registered nurse. Health aides are trained by RNs, and give insulin shots under an RN's supervision. But most children come to school already taught to check their own blood sugar levels, and give themselves insulin shots.

And that, said Gaunthier, points out how individual county experiences can vary.

"I think we do very well with diabetics," said Harter. "We make arrangements to test in the classroom, so children are not sharing lancets with anybody else. And we talk about safety."

Which includes the student who offered to test his fellow students by pricking their finger and testing their blood, Harter laughed.

Get Tested

Look around any room in America. One in every eight people is a diabetic. But two of those eight don't know they're diabetics.

Why should they care? Because diabetes, Gaunthier points out, is the leading cause of blindness, kidney disease, and amputations. And diabetes often causes two other life-threatening conditions, high blood pressure and high cholesterol.

"Over the course of time, diabetes, especially if it's poorly controlled early on, especially if they have high blood pressure and high cholesterol, decreases the blood flow," said Gaunthier.

Diabetics either can't produce insulin, or can't produce enough insulin. Insulin is necessary to feed blood sugar to the cells, which starve to death without that energy. The tiniest cells, and the cells the farthest away from the heart, starve first.

The eyes fit both categories. That's one reason why retinopathy is the No. 1 cause for blindness in U.S.

Which brings this story back to Michael Ackerman and his proliferative diabetic retinopathy: when his retina needed more blood, it sent signals. Abnormal blood vessels proliferated to supply that blood. Ganthier's job was to laser those newly formed vessels, which turned off the signaled demand for more blood.

With less blood in his eye, Ackerman went from being able to read only that big E at the top of the eye chart to 20-30, or being able to read all but two lines above the 20-20 level on the eye chart.

"Two lines away from perfect," said Gaunthier.

November is American Diabetes Month. Any family doctor can test for the disease.

Gary Pinnell can be reached at gpinnell@highlandstoday.com or 863 386-5828

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