May 11, 2022 Diabetic Retinopathy & Sight Loss

So good afternoon and welcome everyone. Uh thank you for being here. My name is Brooks

Roach, manager of Patient Knowledge and Connection with Diabetes Canada. Uh and I'd like to welcome you and begin

by acknowledging that I am joining this webinar from traditional and unseated Mi'kmaq territory. Uh wherever

you're joining watching from I'd like you to take a moment to express gratitude and consideration for the land on

which we live and acknowledge all the past inhabitants of these indigenous lands. I would

like to issue a very warm welcome today to our guests Doctor Valeria Rock and Ryan

Hooey. So, Doctor Larry Rock is an associate professor at the University of Toronto's

Institute of Health Policy, Management and Evaluation. And director the program for health

system and technology evaluation. Doctor Rocket is also co-lead of the diabetic

retinopathy screening research program for Diabetes Action Canada. And was recently awarded a Diabetes Canada

research grant for her work exploring the use of provincial healthcare data in creating a

Canadian diabetic retinopathy screening program. So welcome Doctor Rapids, great to have

you. Thank you so much for the warm welcome. It's great to be here. We are also joined by

Ryan Hooey. So, Ryan lives with type 1 diabetes and experienced sight loss due to diabetic

retinopathy. He is the program lead for CNIB's Come to Work Program. Ryan's also a

passionate advocate for inclusive health supports and a leader in both the diabetes and sight loss community. So, Ryan,

great to have you here and thanks for joining. Thank you so I think you're giving me too

much credit though but I'm very excited to be here and to to drive this conversation and I look forward to all the

questions and and everybody out there. So, welcome to everybody. Thanks, Ryan. Um so,

again, to to those who are, are, are tuned in, watching, or listening, today, we're going to be discussing diabetic

retinopathy, sight loss, and accessibility. So, our two experts here will be addressing

some key points on the interconnection of these issues and providing some strategies for people living with, or at

risk of developing diabetic retinopathy on how to live well, and and potentially prevents when possible diabetic

retinopathy and sight loss. At any point during the webinar, please feel free to pop your questions as a comment on

Facebook and these will be passed directly to our panelists during a question and answer period at the very end.

So, without further ado, we'll we'll dive into some discussion and and I'd like to first pose

a question to Doctor Rock which is wondering if you can provide an overview of diabetic

retinopathy. So, whatever it's, what are we talking about when we talk about diabetic retinop or DR and what are its causes

and symptoms and how does it relate to sight loss? Thank you, Ryan, for the question,

sorry, Brooks. Diabetic retinopathy, I would like to start by saying that diabetic

retinopathy is truly a public health issue. It's a serious vision-threatening complication

of diabetes that is preventable. It potentially impacts around 3 million, over

3 million people Canadians living with diabetes and it does account for approximately

80% of blindness in persons living with diabetes and it is the leading cause of blindness

in working age Canadians. Um just to again give a little bit

more info on how important this condition is and discussing it.

Is that it it is estimated that by 2021 we have now approximately six hundred fifty

thousand individuals in Canada who live with some of diabetic

retinopathy and approximately around hundred 1forty thousand with the severe sight

threatening condition. Um I would also like to mention that

diabetic retinopathy can develop within anyone who has type 1 diabetes or type two

diabetes. And the longer person lives with diabetes and the less controlled their blood

sugar is. Uh it it's more likely to develop this eye complication. Uh it is caused

by the damage to blood vessels by sugar. Uh blood vessels of

the light sensitive tissue at the back of the eye called retina. And then what happens

blood sugar caused the little blood vessels of retina to to

clog basically and to prevent the delivering of the

nourishment and blood supply to retina. As a as a attempt to to

kind of compensate that. Uh our eyes try to develop new blood

vessels. However, those new blood vessels do not develop properly. They can leak easily

and as a consequence to that, there is a damage to the retina. Uh damage can be in the

form of swelling, bleeding, scarring, and in the end, even the scar tissue can literally

peel off retina. Uh as of all, literally and cause a full

deterioration and loss of eyesight. What's a little what's really interesting is

that at the beginning there may be no symptoms or only very mild vision problems. Some of

those symptoms that might be there is like a spots or like a floaters in the eye vision

blurred vision. Uh some dark or empty areas in your vision and then in in can progress to a

full vision if left untreated, diabetic retinopathy can

progress across the four different stages. It starts with a milder,

non-proliferative one where where symptoms as I mentioned might be even fully absent.

Over the time, it can progress to more advanced form of diabetic retinopathy which is

also called proliferative diabetic retinopathy where these new blood vessels are

being developed which are not fully function milk, they can break, they are fragile, they can leak, they can really

damage the retina and cause more severe symptoms of

diabetic retinopathy. So, that would be a kind of a a summary of diabetic retinopathy itself.

Symptoms and also how important this condition is for Canadians living with diabetes. Thank you

very much. Doctor Rapkin. As as our audience can likely appreciates from that, that

answer. It's, it is a complex and, and very multi-faceted condition, and what they may

also be wondering, and this is our next question, is diabetic retinopathy? Can it be

preventable? And if so, what strategies can people use? You referred to self-management of

blood glucose, and time and range, etcetera, but, but what else can, can people explore? Absolutely, so what's very

important to, appreciate that, that early detection through regular diabetic retinopathy

screening is a very effective method of avoiding vision loss. Because by the regular

screening we are enabling early detection and timely treatment

of diabetic retinopathy. It is recommended with the with respect to Canadian guidelines.

It is recommended that all people with diabetes receive regular diabetic retinopathy

screening. Either annually or by annually depending on the risk and of the results of the

previous screening. What is really troublesome that even we have many optometrists, many

ophthalmologists in Canada. Fully equipped to do, to conduct diabetic retinopathy,

screening, our screening rates in Canada are still they've still fall remarkably short of

the recommended rates. So for example, in Ontario, we have around 30 to 40% of people who

are unscreened and who should be screened. And that percent goes even much higher in

certain communities. For recent immigrants, individuals located

in a large cities but living in the low-income communities Uh also individuals living in

remote communities In indigenous members of the indigenous communities. So

healthcare system try to address some of these challenges by really involving

multiple modes of the screening. One of them being tele retina. Which is more how

can I say more flexible with respect to screening and then

screening can be conducted close to patient homes or people's homes. So as I'm as I

started this early detection through regular diabetic retinopathy screening is a very

effective. Uh that's why it's extremely important for people who are living with diabetes to

receive the screening either annually or biennially. Screening exam is very simple.

It basically dilation of the eyes. So the doctor can really

get a better insight into the blood vessels of the eye and retina itself. Uh again very

effective and very easy to do.

Thank you. And and you you mentioned, you know, this this condition progressing in stages

and having, having different degrees. If, if someone's is, you know, listening to, to what

you're sharing and the importance of, of, screening and prevention. If someone is already living with diabetic

retinopathy, or, you know, in, in some degree, is it treatable

and when, what treatments or strategies can you, can you suggest? Absolutely, depending.

So for mild or moderate non-proliferative diabetic retinopathy. Patients may not

need any treatment. People may not need any treatment right away. However it is very

important to receive regular screen screening where the eye doctor will closely monitor the

eyes. And then once the when the treatment is needed patient can get it immediately. In the

meantime if the again it's what is commended. It's a tighter control and better diabetes

management, tighter control of the blood blood sugar levels but for more advanced diabetic

retinopathy, there are different treatment options. So, for example, there are injections with anti VGF, this

growth factor that usually stimulate growth of these new fragile blood vessels. Uh so,

basically stopping that stopping the secretion of the VGF with the injections that

actually stops growth of these new blood and decrease the blood fluid buildup that is

also laser treatment which which actually also acts in a similar way prevents leaks from

abnormal blood vessels. Stops the leakage with the laser. Uh there are corticosteroid

options and vitrectomy for more advanced type of diabetic

retinopathy. What I to mention and which is very important. If the even if the patient gets

treatment for diabetic retinopathy, it is still highly recommended that patient that

people go through the diabetic retinopathy regular diabetic retinopathy screening. Uh even

continuously because at some point the patient may need additional treatment. So,

definitely there are treatment options. That's why it's extremely important to do go ah

for the continuous diabetic retinopathy screening regular screening and then early

detection will give opportunity for different treatment options when they are needed and which

one of them is needed. Yeah, thank you. Thanks, Dr. Robin

and I think Go ahead. It's just Ryan here too. Just just to add on to that too. Myself, I've

lost my sight about 10 years ago due to diabetic retinopathy and even for those that might

be diabetic or might even be someone with vision loss and diabetes, it's still important

to get those eye tests and those eye exams and those screening s done all every single year even if you don't

think your site is changing because I found that over the course of ten years, lots of things have changed that I

didn't notice. So, I was lucky enough to have them catch some things there and really prevent

some some even worse things from happening, believe it or not. Yeah, thanks, thanks,

Ryan, and I think those are really interesting point there that screening is its, is in itself a really powerful form

of treatment, you know, where it can, can give you a deeper look at, at what's going on, and, and show trends over time

that you may not be picking up on, because he's, you know, this is happening at a very, very tiny scale, in, in a lot

of cases, and it may not be these, these shocking moments of a dramatic change in in

quality of of vision etcetera. Um we do have a a quick question from from the audience

that's just on the note of value I'd recommended annual or

biannual screening. By annual that classic prickly term. Are you referring to every two

years or every 6 months? Uh by sorry every two years. So

basically what happens patients are screened at the annual basis. Depending on the results

of the previous screening and also other risk factors. Some

patients then some people may need screaming every two years. So there is a certain risk

certification. But I would definitely patient people living with diabetes to go

immediately. If they didn't have a screening, talk to your physician, ask request

screening yourself. Also, I want to point out if I can if I may, Brooks, one important

thing, not every eye exam is screening for diabetic retinopathy. When we were

developing this team grant, we had a patient partner who was going on a regular basis what

he taught on a regular basis for diabetic retinopathy screening. However, it wasn't

full diabetic retinopathy screening with the dilation of the pupils with a really good

closer look inside the eyes to see the blood vessels, to see the retina, and in the end,

patient did end up unfortunately with diabetic retinopathy, not because he didn't attend like exams. It

just was not a comprehensive diabetic retinopathy screening type exam. Great, great point.

So, yeah, to our audience, yeah. If you're, if you're in question, make sure that what you're, what you're attending,

you know, because you may be very diligent in attending. Make sure that it is actually, in fact, screening for diabetic

retinopathy on a, on a regular annual or by annual, every two years basis, depending on, on

what your healthcare provider says. Brian, you, you spoke a bit to your experience of, you

know, over the past 10 years, and I wondered if you could share a bit more about more

generally living with sight loss and and any advice or recommendations you could you could provide to our audience.

Uh for people who are living with or maybe at risk of retinopathy or sight loss. And

I guess the the core question is where have you found successes? And what advice would you provide there? Of

course. No. My life is is very very public in that regard. Uh working for the CNIB and being a volunteer for Diabetes

Canada. Um I I tend to talk a lot about diabetes and a lot about vision loss. Um I'm

thirty-five years old. I've been type 1 diabetic since I was seven. Uh and just 10 years

ago I lost my sight due to diabetic retinopathy. But my

journey's a little bit unique. And I know everybody says that but in terms of you know screening and things like that

I was getting my my eye test done and I was a scholarship athlete playing baseball in the

States. But all of the blood vessels just like we heard from the doctor a little bit earlier. All of mine kind of

decided to go wacky one night overnight. And they crushed my retina and and I actually have

retinal detachment in both eyes Uh they have since been repaired but they're not really

helping my eyesight out at all. Uh so I do have a little bit of light perception but other than that, it's not too much. Um

it's really changed my life and I can safely say that without the support from the CNIB, from

my friends, from my family members, and my loved ones, I wouldn't be where I am today. Um knowing when to ask for help

and when to fight those battles of independence is really, really key. I'm a father of a

two year old, a little girl named Abby, and I'm also a guide dog user, a yellow lab, who is three and his name is

Joe. He's my first guide dog. So, I'm really proud of that moment and I think successes

when it comes to diabetes care is there's a lot there and again, I'm not a medical

professional, so I can't really, you know, give you the medical side of things, but just some tips and tricks on

what I do, and there's a lot of new accessible sort of technology that's either on the

cusp, or they've kind of implemented, and it's, it's kind of being pushed out now. For me, the big part was, I

couldn't see my sugars when I'm using a glucometer, I can, I could test my blood sugar. I

could kind of find the blood on my finger. You know, you you kind of have tips and tricks to learn from there. It's sort of

a trial and error but once you test, how do I know what my sugar is? An eight looks like a

six if I'm holding it right up in front of my face but now, there's the Libre, there's

continuous blood glucose monitors, and those all hooked to your iPhone. Or to an

accessible device, right? So, looking at that, it reads it out to me. So, Apple has done a

lot of the lifting, implementing voice over, and implementing some other things that are very accessible to, to

managing my diabetes, looking at trends, I can send them to my doctor, I can send them to my endocrinologist. However,

you know, I don't, I can't really use the graphs too much. I don't know because it's so visual, how how you would

actually make that accessible, to be honest, maybe that's something to consider. Um, as you had said before, we're

fighting the good fight right now at CNIB, Diabetes Canada a few other organizations by

trying to get an accessible insulin pump out. Uh for instance, my pump is about 10

years old and it's not accessible. I don't I can't even tell you how much batteries left in the battery

right now because it's all visual on the screen. There's no app. There's no voice output

even a lot of the notifications sound the same. So, I sort of have to know when was the last time I refilled my reservoir?

Is it about that time? Because that notification is the same as low battery is the same as,

oh, you're, you've been out in the sun too long, your pump's too hot. So, you sort of have to kind of really remember

things. So, my pump can kind of be classified as a very fancy insulin pen 'cuz it is

continuously giving me the insulin which is great but I'm still doing all the calculations in my head and

testing with an outside source because it's just not accessible. So, we're hoping to kind of make some more

headways. So, if anyone is interested, please feel free to reach out to me and we kind of get going with that. Um Brooks,

I have a question for you. There's two things here and I tell this story all the time but when I lost my sight, there

are two things you probably do every single day but what are the two most complicated things you think were for me to

relearn how to do? Put me on the spot here, Ryan. I don't

want to give you any chance to prepare. Diabetes Care, I mean, first

and foremost, food preparation. I'm going to

take a stab. So that that's kind of one of them. One of them was measuring foods but I

was thinking in terms of I cannot butter toast. Half of my toast will have 14 inches of peanut butter on it and the

other half will have none. Even though I think I did it right. Uh the other was finding blood on my finger to test my blood

sugar. Or recapping the insulin pen needle. So many times I had

poked my fingers and and poked myself and it's it's really interesting. I don't know that

there's an accessible way to kind of do that. You just sort of gotta get on with the grind, right? But I, I, I always laugh

now looking back at that because the pump is a real game changer. It's just, we're not quite there yet, right? We're

almost there. So, I'm just hoping that once one pump company manufacturer jumps on

board, usually, nobody wants to be the first. They always want to be a quick second. So, I'm hoping that we'll be able

to to get some good things rolling here. Yeah, thanks, thanks for sharing, Ryan, and

it's, you know, I think within what you're talking about, there's this sort of theme that people offer here, which is, a

lot of the time, it's those behaviors that you've, you've learned that kind of feel second nature, that are the

hardest to get used to post diagnosis, and that's generally with, with diabetes, we often

hear that, no, it's, it's, preparing a meal, and then there's this added element of,

not only preparing a meal and being able to, to count carbs and, and manage it that way, and track what's going on in

your body, but also to, to literally do the thing, and to, to do it in a, in a measured, calculated way So, yeah, I I

really appreciate sharing that, right? Cuz it's, again, these are smaller moments that people don't often necessarily think

of. No, absolutely and to to the the audience out there, you know, I always tell this all of

my clients that I help out. Um the only silly question is the one that goes unasked. So, for as wild as you think your

question might be, I've probably been asked something a little bit more wild. So, feel free to to ask away. I'm pretty

open and you can't help but laugh at yourself because I do some funny things without my sight I just wouldn't do if I

had my sight right? And I'm wondering, I'm

going to follow up on on your mention of the importance of accessible devices, and, you know, many people in our

audience, take advantage of the some of the wonderful

technologies that are out there. Whether that's a continuous glucose monitor or insulin pump or a pen or or

even medications which often have to be, you know, there's an element of of visual tracking going on there. Um if

they were, if they're hearing what you're saying and and it and this is striking a chord or if this is something folks weren't aware of, where would

you steer them? Where could they get involved or make their voice heard? Absolutely. So, I think the first thing that you

have to point out though too is that there's never going to be a perfect accessible device. There's always going to be some

sort of flaw, right? So, for instance, with with the Libre, it's awesome. It it talks to me

but you have to have a cellphone. Maybe not everybody could afford a a smartphone, right? Kinda thing. So, there's

not going to be the one be all and all fix, you know, cookie-cutter kind of situation, right? for now, if

you're looking to kind of join forces with us, you can reach out to me through through my email or find me on Facebook

and we can chat. A lot of people have done that and we can also go to CNIB CA and we

don't really have a fancy URL yet where it's like slash accessible pumps or anything like that. So, you would have

to root around a little bit on there but there is a search box I believe in the top right corner. If you type in

accessible pump campaign. A ton of stuff will come up and there's a ton of contacts. There's what we've done year to

date. What we plan to do over the next year and how we've partnered with the National Federation for the Blind in

America. How we partnered with Diabetes Canada and how we've had three of the four national

pump companies here in North America signed on saying hey we will do better. We will try and

figure this out and we will kind of get moving on finding somewhere to make our pump

accessible. Thanks a lot, Rand. Of course. Doctor Rock, is

there anything before we open the floor to some of the questions we've received? Anything you'd like to add or

any final points on screening prevention or or given what Ryan's mentioned on some of the

steps that need to be made and are being made on improving accessibility of care.

Absolutely. So one thing that I will emphasize again, please, if you are living with

diabetes, make sure you have your eyes checked. That's talk

to your physician. Uh either your primary care doc. If you have a specialist

endocrinologist that you work with, voice your concerns and request eyechair, diabetic

retinopathy screening, check eye exam. It's simple. It's painless, and it can really

really help you save your vision as as much as you can. Uh second point, again, as I

mentioned, follow up the guidelines, guidelines, our annual screening, in some cases, if you are at the risk

of developing diabetic retinopathy then you may need to screen your eyes every two years. And I also think just to

build upon what Ryan mentioned I think we we still have a lot of work to do. Ah when it comes

to innovative technologies to make ah to to to make ah life

ah better ah for people living with diabetes and ah especially for people experiencing ah

vision loss ah and ah I'm hoping that I have the opportunity potentially to

connect Ryan with one of the we have incubators. Uh incubator at UHN which is really very

forward thinking with respect to developing different technologies for people living with different conditions like

heart failure, COPD, and diabetes. So, as a result, just to give you an example and it's

not necessarily for diabetes, they are developing smart fibers that can measure certain

body parameters just by and and regulating just by let's say

having a vest or having a socks. So it might be something

also worth and I will definitely talk to the group who is super creative at kite

to bring you potentially Ryan with some of your to describe some of your challenges that

you you very well you vocalise it so well from your lived experience and put some

engineering minds together to potential create something. I welcome the opportunity. The

more the more people that know the better, even if it's just to get the word out, but thank you for that connection.

Appreciate it. My pleasure. Happy to do that. So, thank you

folks. It's this is really, really exciting to see, you know, the, for the audience you're witnessing, you know,

partnership in action, and the importance of, I think, also, the, the power that can come

from sharing a story. So, kudos, Ryan, for, for being open, and, and speaking to the

need for this, and, and, and Val for being receptive, so exciting things can happen. Um,

on that note here a bit more. Uh we do have a couple questions from from our audience. So, we'll start off

and this one, it may be a bit directed to, to both of you, and it's, it's a question from, from Dawn, who's asking, Dawn

just had a cataract replaced a week ago, and it's been extremely painful since, and Don is wondering if this is to

be expected. Hey, Don. It's Ryan here. Um I actually had a

cataract under my right eye two and a half weeks ago. Um keep

on with the eye drops. They tell you to do them for a reason. Uh even though it might be difficult and it it it does

get better. Um again, not a medical professional but the the first about week is the

worst and then after that, you sort of start to notice some things and where your your eye

patch, your eye shield to bed because I'm notorious for waking up and starting to rub my eyes. So, I I know what

you're going through and I'm I'm very sorry you had to go through that but I hope it's not affecting the vision. Um if

if you do, are you, if you are someone living with vision, that would be the concern if it is, but if it's, kind of, you

know, little painful, a little sore at this point. Um, usually the swelling and everything

will go down little by little. It affects everyone so differently and if you're a person with diabetes, you know

what, keep those sugars in check, because your body's more concerned about getting your sugars back to the normal range

than it is about healing a cut or a bruise or a scrape. So, if you can do that, it'll help,

it'll help wondrously for you Thanks, Bryant. Hope, yeah,

likewise, hope it, hope you get well soon, Don, and, you know, Brian, thanks for sharing that.

We, we have a question from Tebotina and Caroline, who are

wondering about the correlation between A one C, and and the

rates of increased retinopathy, or, or risk of retinopathy. So, basically, both are wondering, Tina's wondering, as a nurse

educator, they've seen patients who had good glycemic control, and still did retinopathy and

then Caroline is wondering if there's an AoneC level where it becomes more likely to occur or

you know, where where it enters into more quote unquote risky territory. It's thank you for

the question. It's it's there is a kind of assumption that if

blood sugar levels are in a tighter control, it's less likely to develop. However, I

wouldn't necessarily just go by that. I would still recommend again annual check for diabetic

retinopathy. Uh people respond differently. We heard even from Ryan how his vision loss was

absolutely sudden. Uh even though he he did all the diabetic retinopathy screening

s on time. So I would definitely I wouldn't necessarily say that you know

it is assumption that tighter control of the blood sugar level. It's less likely to develop but anyway I would

strongly recommend go and check your eyes.

Thank you. Um we have Linda who who says that Linda lives with

diabetic retinopathy as well as macular degeneration. Um and the response when Linda shared

with healthcare provider was what did you expect? You didn't take one diabetic for 30 years.

And did not suggest next steps. So I I think the question that I might pose to both of you here is is what advice might

you have when concerns or or difficulties of you know living

with sin challenging condition like this. Uh are minimized by healthcare provider and and

around advocating for oneself or what can what kind of person do then. It's Ryan. That's a

that's a difficult situation. I'm very sorry that that you're going through that. Um but the first and foremost and I tell a

lot of people this because I do get similar type questions all the time is that don't be

ashamed of your vision loss. Um it's not your fault. Uh it's it's you know what? It's it

unfortunately might just be a fact of life right? And it's it's it's hard to understand

what people are going through even myself with your we might have the same eye condition but

what you see is completely different than what I see and we won't be able to sort of describe to each other. So, I

think it's hard to describe to the sight ed world that, hey, we're visually impaired or we

might even be, you know, blind, because there's just no way to understand it, and I don't mean

to take that away from the side of the world, it's just, it's, it's really hard to understand. So, you have to really advocate

for yourself, be, be assertive, but don't be mad. A lot of people think that advocating

means, let's get angry and yell and scream and we'll get what we want, and I can tell you from experience. I can tell you

from seeing it from others. That's not how you get what you want. You sort of have to

tiptoe that line of being assertive, not aggressive, kind of thing, and it's it's very

difficult, much easier said than done, but if you are looking to to, to talk to

someone, I can, I can be that someone, and you can feel free to reach out to me anytime, and we can sort of put you in touch

with the CNIB advocacy team, and we can see, how they can help, and, and how I can help, 'cuz it sounds like we might

have been through some of the same things. So, I do apologize but I hope we can we can find

you the right help. And I would just like to add that it's very

unfortunate that healthcare professional responded like that. Because every experience, every lived experience is a

valid lived experience And nobody has the right to take that away from from anyone, any

of us. So I'm I'm really, I apologize on on, on, for that

healthcare professional, that was not compassionate. That was not something that actually

should support patients whom we care for. So on the on the

other note I completely agree with Ryan that it is working basically you are advocating

for yourself. Uh it's unfortunate that your voice could not be amplified by your

healthcare professional because it should have been. Uh so on another note I I would also

think in a way recommended maybe if you have opportunity look potentially for other

healthcare professional who may that. Uh it's there is no right

or wrong in changing the the provider who does not meet your needs. I think definitely your

needs were not met with that comment, not your physical needs and your emotional needs.

So, I think you deserve a a person definitely who will be a better position to, to do that.

So, also think about that, as well, if you have the opportunity to look for a a

provider who definitely amplify your amplify your voice and

your concerns and your needs. totally agree. Thank you. Thank

you, Dr. Rock and I think hearing that from ethical professional like yourself can,

it's really helpful to to hear that. So, thanks for saying that. I have a question from Caitlin Rose who's saying,

they've been living with diabetic retinopathy for four years and when both eyes bleed

and are blurry, they can't see their insulin pump. Now, they also use CGM. This really does

help to be able to ask Siri. So, Ryan to your point about having connectivity with a

smartphone to ask in this case an iPhone, what's my sugar and letting the pump calculate and

administer insulin. So, Kaitlyn Rose is is just curious about speaking more with Ryan about options that have helped and

and might be looking for some individual advice. So, Ryan, any any quick advice we we've also shared your your contact

info with with Caitlin Rose. Perfect. I was going to say feel free to toss up my email to anybody who asks not a

problem at all. Uh and I feel not not to not give you an answer, Caitlin, but that's a much longer discussion probably

than we have time for here today. So, the sooner you can reach out to me. No rush. Take your time. And when you feel

comfortable and only share with me what you feel comfortable sharing. But we can definitely take this conversation offline

and we can see if we can sort of look at getting you in contact with some some people

that might be able to help with some accessible technology and and some of the options that are available out there.

one final question and unless folks have had more, please do feel free to to ask but this question is from Randy who's

asking if someone is already suffering with diabetic retinopathy. Um just looking

for for confirmation on is there a way to reverse it? Is there a way to perhaps, you

know, treat it really significantly to to get reversal.

so I I have to say I'm not an eye doctor. So I would definitely recommend that you

talk to your ophthalmologist, your eye doctor about that. Um

in many cases unfortunately the damage that is done. Uh it's irreversible. What's usually

may happen is basically what what we need to do is stop progression of the of the

further progression of diabetic retinopathy. But again I'm not ophthalmologist. I'm not eye

doctor so I would strongly recommend you talk to your eye doctor about but definitely

there is there are treatments that can stop progression of of diabetic retinopathy

retinopathy. It's Ryan here too. I'm also not a doctor but

I ask that question every time I see my eye doctor, you know, is is there something that can

reverse what's already been done and I get the either the depending what mood he's in,

then not yet. If he's in a good mood or the sorry, unfortunately, there's not. So,

as far as as far as I know and that's, you know, me being the third party telling you from my

eye doctor, that's that's what he's told me. So, and I trust him. He's done a lot of work on my eyes.

and so hope that I hope that helps, Freddie. Cuz it is, it's a very individualized answer

that your healthcare provider will be able to answer best. Mm-hmm. Seeing no more

questions we'll move to, to wrap up, and I just like to sincerely thank our audience

for the, the thoughtful and, and, and interesting and helpful questions. As they say,

if you, if you're wondering if there's, there's like the many more who, who are curious and didn't ask. Um, for those who

are looking to learn more and stay up to date on this topic and more, Diabetes Canada is, is here to help, so you can

visit our website at Diab dot CA. You can go to our social media at Diabetes Canada and

you can always also call our helpline at 1-800 Banting or email info at Diabetes. CA for

any specific questions and we'll do our best to help you. I'd like to give a huge thank

you to our guests. So, Doctor Rock and Ryan, thank you very much. Uh we're nearing the end

of our time together but before we close off, do you have any final remarks for our viewers?

It's Ryan here. Just want to say thanks for the opportunity and thank you for the wonderful audience engagement. That was

great and hopefully we can do this again. Absolutely. I will

echo this and I will also mention that we have quite a few big national studies

ongoing. So, if people are interested to participate and shape the research that we are

doing with respect to diabetic retinopathy, Brooks has my email. I'm my contact

information. I'm more than happy to and will be privileged to work with any of you who is

interested. So again, Thank you for the thoughtful questions and great engagement today.

Thanks very much and as mentioned there there are plenty of opportunities to to get more involved. Whether that's in advocacy around

accessible devices and I know as as Ryan mentioned you can visit CNIB. CA. Um they can

direct you further there as can we. Um and if you'd like to get involved in in research and and

or if you're just curious to see what's going on. Uh we can we can steer you that direction as well. So don't hesitate to

reach out. Um I hope this webinar has been helpful for you, anyone in our audience, and want to wish you all the

best. So, thank you and and take care. Thank you.