Cotton Wool Spots

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Josh F Posted: Wed, Feb 11 2009 5:38 PM

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So I am 34, diagnosed at 5 with type 1. I have moderate NPDR with nothing more than some micro anarysms and cotton wool spots. I was told I am very sensitive to seeing any changes in my vision, as I was informed CWS don't generallycause visual disturbances.  But how can that be true? It is a ishemic disturbance. They do fade mostly, but I have a few that have not really changed in years...almost 3 years two towards the optic nerve have maintained their size and density . My doctor from Beetham at Joslin has been great, but i know my fear of continuing damage to my eyes via CWS's seems like something i need to get an emotional handle on. I am doing everything in my power to stabilize my sugars ( i take 10 -15 tests a day, but because i am only on fast acting insulin, if any thing goes wrong with the tubing or site with the pump, i just jump right up. It is very frustrating.

I got another large one over the weekend, and it bothered me because I have been getting quite a few lately. I am a fairly brittle diabetic and am going to get on the Continuous Glucose monitor, so I can really even out...as I have been on the pump, but my levels still swing quite a bit sometimes. 

I went through a divorce last year and obviously my control suffered..so My A1c went up to a 8.9 after being in the low 7's and high 6s for a while. ( much better than the 10-13s I used to have when I was a teenager), but I went to a 8.9 a few months agao and my last one was a 7.4...i want to get better than that obviously due to the eye issues.

My question about cotton wools spots for those that have them...do they generally cause you visual disturbance or go mostly unnoticed? I get them peripherally, but also get them closer to the middle region, and they fade some, but the damage always seems to be there.

I guess what confused me was one of the Beetham eye specialists thought it was odd I could see them and that they resolve in time (anywhere from 4 weeks to a few months) Do I just have the bad luck of getting permanant and dark ones? That scares me because it is not like even laser could help that situation...

;-(

I know this post seems like I am rambeling...I guess i am just a little freaked out. Even after 8-10 years of having mild-moderate NPDR I still can't sometimes deal with vision changes. mainly because I am a professional designer and artists...and it is how I I dentify myself as a person. So everytime I lose a small spot of sight, I feel there is a small part of me that goes with it.

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Simi_Papa replied on Wed, Feb 11 2009 9:08 PM

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I think everyone gets eye "floaters", what you refered to as cotton wool spots.  They can be annpying at times, but shouldn't have a permanent affect on your vision.  Have tried using eye drops to flush your eyes?  Seems like that should help.

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Ron AKA replied on Wed, Feb 11 2009 9:16 PM

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Josh welcome to the site. I have not had any eye issues but have been seeing a retina specialist to be sure they are caught early if I do. Here is a link to this specialist's site and what he has to say about NPDR. As I read it there are 4 stages, and mild NPDR is the second one. It should not be causing any vision problems, and does not require treatment unless it is accompanied by macular edema.

Diabetic Retinopathy

In addition to tight BG control there is some research showing benefits in tight control of BP and cholesterol. ACE inhibitors and statins like Crestor and Lipitor can make significant improvements in BP, cholesterol, and long term risks. Something to discuss with your doctors.

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Josh F replied on Wed, Feb 11 2009 9:58 PM

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Thanks for the responses.

I understand the stages pretty well actually. I guess my specific question was why some CWS's remain while othere fade.

They are not floaters.I wish.   Cotton wool spots are retnial infarcts, caused by ischemia to the nerve fibre layer.  The eye does not get enough oxygen and small patches swell around blocked capularies....The cause is not the question...I am just asking others who have NPDR if they have experienced the same redisual edema or halo from them...which can sometimes never resolve. Most doctors say they do resolve and do not threaten vision..I find it to not be the case with mine. I wanted to know why the differences...is it location or the depth of the infarct.  ;-)

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rods41 replied on Tue, Mar 24 2009 1:38 AM

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was diagnosed 3 weeks ago with type 2.  only symptom was visual disturb in left eye..CWS's. the largest of the 3 was the infarct right in my center of vision.  I am still unsure of the permenence of this.    my BG went from 420 fasting  to now, 3 weeks later, 130.  My vision got much worse due to my drastic drop in BG level..but has now finally leveled out (Thank God).  However, my original issue is still the same..still have the "blind" spot in the center of my vision.  Going back to my Optho in 2 weeks for another look.  Hoping it gets better by then...but so far...it is no better.....but no worse!