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New Research: The Argus II Retinal Prosthesis (Bionic Eye) Is Safe, Effective, and Improves Visual Function

Cover of the journal Ophthalmology

New clinical trial results from the Argus II Study Group, an international consortium of eye and vision researchers, confirm that the Argus II, also called the "bionic eye," is a safe, reliable, and effective device that "significantly improves visual function and quality of life for people blinded by retinitis pigmentosa."

The latest research, entitled Long-Term Results from an Epiretinal [i.e, "on," "upon," "near," or "against" the retina] Prosthesis to Restore Sight to the Blind, has been published online ahead of print, as an open-source article in the July 2015 edition of Ophthalmology, the official journal of the American Academy of Ophthalmology. Ophthalmology publishes original, peer-reviewed research in ophthalmology, including new diagnostic and surgical techniques, the latest drug findings, and results of clinical trials.

The authors are Allen C. Ho, MD; Mark S. Humayun, MD, PhD; Jessy D. Dorn, PhD; Lyndon da Cruz, MD; Gislin Dagnelie, PhD; James Handa, MD; Pierre-Olivier Barale, MD; José-Alain Sahel, MD; Paulo E. Stanga, MD; Farhad Hafezi, MD, PhD; Avinoam B. Safran, MD; Joel Salzmann, MD; Arturo Santos, MD, PhD; David Birch, PhD; Rand Spencer, MD; Artur V. Cideciyan, PhD; Eugene de Juan, MD; Jacque L. Duncan, MD; Dean Eliott, MD; Amani Fawzi, MD; Lisa C. Olmos de Koo, MD; Gary C. Brown, MD; Julia A. Haller, MD; Carl D. Regillo, MD; Lucian V. Del Priore, MD; Aries Arditi, PhD; Duane R. Geruschat, PhD; and Robert J. Greenberg, MD, PhD. All authors are members of the Argus II Study Group.

You can read our interviews with authors and Argus II Study Group members Dr. Duane Geruschat and Dr. Aries Arditi on the VisionAware blog.

Some Background on the Argus II

the Argus 2 system

The Argus II was developed by Second Sight Medical Products, Inc., of Lausanne, Switzerland and Sylmar, California to treat adults with severe to profound retinitis pigmentosa (RP). RP is a rare, inherited degenerative disease that damages light-sensitive cells in the retina, resulting in decreased vision at night or in low light; loss of side (peripheral) vision; and loss of central vision as the disease progresses. At present, there is no cure for RP.

The retina is the light-sensitive tissue that lines the inside surface of the eye. Cells in the retinal tissue convert incoming light into electrical impulses. These electrical impulses are carried by the optic nerve to the brain, which finally interprets them as visual images. The Argus II is not a cure for RP; instead, it is intended to replace the function of the light-sensing cells that have been damaged and/or degraded by the disease.

The Argus II device consists of the following components:

  • a small video camera
  • a transmitter mounted on a pair of eyeglasses
  • a video processing unit (VPU)
  • an artificial retina (the implanted retinal prosthesis, which is an array of electrodes)

The video camera images are transformed into electronic data by the VPU that sends signals to a wireless receiver implanted in the eye (the retinal prosthesis electrodes). The electrodes allow the electronic signals to bypass the damaged retina and transmit directly to the brain, where they are interpreted as visual images.

The cost of the Argus II is approximately $100,000; additional fees include the implantation surgery and training to use the device. The Second Site website provides an illustrated system overview, including a video animation.

On February 14, 2013, Second Sight received approval as a Humanitarian Use Device (HUD) from the U.S. Food and Drug Administration (FDA) for the Argus II. The HUD designation is an approval specifically for devices intended to benefit small populations and/or rare conditions. On August 15, 2013, Second Sight announced that the Argus II was approved by the Centers for Medicare and Medicaid Services (CMS), beginning October 1, 2013. You can learn about all ongoing Argus® II clinical trials at the ClinialTrials.gov website.

Who Is Eligible for the Argus II?

The Argus II is implanted in a single eye, typically the worse-seeing eye. It is indicated for persons with severe to profound RP who meet the following criteria:

  • Age 25 or older
  • Have bare light or no light perception in both eyes: Bare light perception is the ability to perceive light, but not the direction from which the light is coming. If the person has no residual light perception, then evidence of intact inner layer retina function must be confirmed.
  • A previous history of useful form vision
  • Be aphakic or pseudophakic: Aphakic means that the eye is lacking its natural lens. Pseudophakic means that the eye has been fitted with an artificial lens implant (as in cataract surgery) to replace the missing or surgically removed natural lens.
  • If the person is phakic (i.e., has a natural lens or an artificial lens implant) prior to the Argus II implant surgery, the lens will be removed during the implant procedure.
  • Be willing and able to receive the recommended post-implant clinical follow-up, device fitting, and visual rehabilitation.

About the Latest Argus II Research

Excerpted from Bionic eye clinical trial results show long-term safety, efficacy, of vision-restoring implant, via Medical Xpress:

The latest three-year clinical trial results of the retinal implant, popularly known as the "bionic eye," have proven the long-term efficacy, safety and reliability of the device that restores vision in those blinded by a rare, degenerative eye disease. The findings show that the Argus II significantly improves visual function and quality of life for people blinded by retinitis pigmentosa.

Graphic of the Argus II

To further evaluate the safety, reliability and benefit of the device, a clinical trial of 30 people, aged 28 to 77, was conducted in the United States and Europe. All of the study participants had little or no light perception in both eyes.

The researchers conducted visual function tests using both a computer screen and real-world conditions, including finding and touching a door and identifying and following a line on the ground.

A Functional Low-vision Observer Rated Assessment (FLORA) was also performed by independent visual rehabilitation experts at the request of the FDA to assess the impact of the Argus II system on the subjects' everyday lives, including extensive interviews and tasks performed around the home.

The visual function results indicated that up to 89 percent of the subjects performed significantly better with the device. The FLORA found that among the subjects, 80 percent received benefit from the system when considering both functional vision and patient-reported quality of life, and no subjects were affected negatively.

After one year, two-thirds of the subjects had not experienced device- or surgery-related serious adverse events. After three years, there were no device failures. Throughout the three years, 11 subjects experienced serious adverse events, most of which occurred soon after implantation and were successfully treated. One of these treatments, however, was to remove the device due to recurring erosion after the suture tab on the device became damaged.

More about the Study from Ophthalmology

From the article abstract, with the full open-access article (PDF) available online:

Purpose: Retinitis pigmentosa (RP) is a group of inherited retinal degenerations leading to blindness due to photoreceptor loss. Retinitis pigmentosa is a rare disease, affecting only approximately 100,000 people in the United States. There is no cure and no approved medical therapy to slow or reverse RP.

The purpose of this clinical trial was to evaluate the safety, reliability, and benefit of the Argus II Retinal Prosthesis System in restoring some visual function to subjects completely blind from RP. We report clinical trial results at one and three years after implantation.

Participants: There were 30 subjects in 10 centers in the United States and Europe. Subjects served as their own controls, that is, implanted eye versus fellow eye, and "system on" versus "system off" (native residual vision).

Methods: The Argus II System was implanted on and in a single eye (typically the worse-seeing eye) of blind subjects. Subjects wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina.

Main Outcome Measures: The primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by three computer-based, objective tests.

Results: A total of 29 of 30 subjects had functioning Argus II Systems implants three years after implantation. Eleven subjects experienced a total of 23 serious device- or surgery-related adverse events. All were treated with standard ophthalmic care. As a group, subjects performed significantly better with the system on than off on all visual function tests and functional vision assessments.

Conclusions: The three-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind from RP. Earlier results from this trial were used to gain approval of the Argus II by the Food and Drug Administration and a CE mark in Europe. The Argus II System is the first and only retinal implant to have both approvals.

VisionAware will continue to report Argus II research updates as they become available.

Additional Argus II Information at VisionAware

Argus II images provided by Second Sight Medical Products, Inc. Used with permission.


Topics:
Low Vision
In the News
Technology
Medical Updates
Clinical Trials
Retinitis Pigmentosa

Calling All Advocates: White House Conference on Aging Set for July 13

Priscilla Rogers wearing a blue shirt

Guest blogger Priscilla Rogers, Ph.D. is the Program Manager for VisionAware and co-author of Aging and Vision Loss: A Handbook for Families. Her other works include Self-Advocacy Skills Training for Older Individuals Who Are Visually Impaired and Solutions for Success: A Training Manual for Working with Older People Who Are Visually Impaired. She has an M.A. degree in gerontology and a Ph.D. in special education with an emphasis in vision and aging.

The 2015 White House Conference on Aging

The White House Conference on Aging (WHCoA) is a once-a-decade conference, sponsored by the Executive Office of the President of the United States, that makes policy recommendations to the president and Congress focusing on the needs of older Americans. 2015 is an especially critical year for the WHCoA, with the convergence of the 50th anniversary of the Older Americans Act, the 25th anniversary of the Americans with Disabilities Act, and the 50th anniversary of Medicare and Medicaid!

2015 White House Conference on Aging logo

These programs are critical to older Americans with vision loss. Almost 50 percent of Americans over 64 reported some level of disability in the 2010 census, with over 13.5 percent reporting difficulty seeing.

However, according to the input the American Foundation for the Blind (AFB) received in our recent online survey and national conversation at our 2015 Leadership Conference, it is clear that older Americans with vision loss are not receiving the rehabilitation or support services needed to maintain independent lifestyles or, in some cases, to meet the most basic of everyday needs.

Major Issues Identified

Here are some of the major issues that have emerged from our initiatives :

  1. The primary health programs serving older Americans, Medicare and Medicaid, do not cover technology and specialized services (e.g. low vision services and vision rehabilitation services) for older Americans who are blind or visually impaired. A comprehensive reevaluation of systems serving older Americans should ensure fiscal support, coordination of research, and dissemination of services and assistive technology to enhance independence and quality of life for persons who develop vision loss at any stage of life.

  2. Funding for specialized services for older adults with vision loss is insufficient. Important services do not reach many of those who have the greatest need of assistance – including those in rural areas, those who are isolated from social and family networks, and those who have additional disabilities and medical conditions (especially deafness/hearing loss, memory loss, and diabetes). At a minimum, full funding is needed for the Older Individuals Who Are Blind (OIB) program, a federal program authorized by the Vocational Rehabilitation Act and administered through vocational rehabilitation services in each state.

  3. The number of qualified professionals providing supports for adults with vision loss is vastly inadequate to meet the service delivery needs of the growing population of older Americans with vision loss. Targeted funds are needed to support training and employment of vision professionals, as well as to provide pre-service and in-service training for service providers, caregivers, and health-care workers who provide in-home, community-based, and residential services.

  4. Older Americans with vision loss can continue to live independent and fulfilling lives if given access to appropriate home and community-based supports for carrying out everyday tasks. Seniors should have access to qualified, trusted assistance for reviewing printed materials and managing finances in a way which respects their independence and privacy. Additionally, all Americans – particularly seniors – benefit from affordable, reliable public transportation access, not only for medical appointments and groceries, but for social activities, visiting family, and pursuing their retirement goals and aspirations.

  5. Economic security is even more precarious among older Americans who are likely to have had fewer employment opportunities or to have retired early due to unexpected vision loss. These individuals significantly economically disadvantaged as a direct result of their vision loss. Title V of the Older Americans Act should be amended to require that programs funded through Title V provide assistance to these individuals, regardless of income status.

  6. One respondent shared the following economic observations with AFB: "Many individuals were diagnosed after retirement and did not even think about planning to have finances to pay for video magnifiers; co-payments for injections related to macular degeneration; in-home assistance; or options for transportation. Those who do not have the financial resources do without; those who have financial resources found that retirement funds have to be diverted from more fun/social expenditures to 'eye care needs.'"

What Can You Do To Help?

AFB is looking for organizations to sign on to our advocacy letter to the President of the United States. To participate, review the letter and the report and email your organizational signature to AFB in care of Rsheffield@afb.net. We need your support by the close of business on June 25, 2015.

Remember, only organizations can sign on to this letter. However, individuals are urged to write their own letters and/or participate in the following ways:

Read Other Posts about the White House Conference on Aging


Topics:
Planning for the Future
Assistive Technology
Low Vision
In the News
Personal Reflections
Health
Employment
Technology
Public Policy
Aging

Our Readers Want to Know: What Is the Role of Lasers in Cataract Surgery?

Editor's note: One of the many benefits associated with an online information center and website, such as VisionAware, is the ability to track readers' search terms [i.e., information readers are seeking as they search the Internet]. Since the earliest days of VisionAware.org, the following questions about cataracts and cataract surgery consistently rank within the top ten searches and are especially relevant during Cataract Awareness Month:

  • Is it true that cataract surgery now can be performed entirely by laser?
  • How can I find out more about laser surgery for cataracts?

An Answer from Tina D. Turner, M.D.

Tina D. Turner, MD

This week, our answer comes from Tina D. Turner, M.D., a staff comprehensive ophthalmologist at Henry Ford Health System's Grosse Pointe Ophthalmology and author of An Introduction to Cataracts and Cataract Surgery on the VisionAware website. She lectures widely on many topics in ophthalmology to ophthalmology residents, family medicine residents, emergency medicine residents, ophthalmic technicians, surgical technicians, and patients.

Performing Cataract Surgery

Most cataracts are highly treatable. Cataract surgery is one of the most common surgeries performed in the United States, with approximately 98% of patients experiencing improved vision if there are no other eye conditions present.

Two very small incisions (one larger, approximately three millimeters, or one-tenth of an inch, and one smaller, approximately one millimeter, or one thirty-second of an inch) are made in the cornea, which is the transparent dome-shaped tissue that covers the front part of the eye. A thick, sticky, glue-like material (called "viscous") is injected into the front part of the eye to help maintain its shape during surgery. This material is made from substances that occur naturally in the body. Because it is thick, this material will not leak out of the incisions during surgery.

Phacoemulsification

The surgeon creates an opening in the natural "sac" or "bag" that holds the lens in place, called the lens capsule. The lens is separated from the lens capsule by using a balanced salt solution.

Once the capsule is open and the lens can move freely inside the capsule, a special ultrasound device is used to break the lens into small pieces and suck it out of the eye. This technique is called phacoemulsification.

Prior to the development of phacoemulsification, the lens used to be removed in one solid piece through a very large incision (8-12 millimeters). That surgery entailed considerably more risk and had a significantly longer recovery time.

After the lens is removed, additional viscous material is injected into the lens capsule to hold it open and make room for the new artificial lens. The folded artificial lens is inserted into the "sac" or capsule, where it is then allowed to unfold.

The viscous material that maintained the shape of the eye during surgery is removed. The two incisions usually self-seal and do not require stitches.

Phacoemulsification was introduced more than 40 years ago and is now the most common method surgical method used to remove cataracts.

The Femtosecond Laser Does not Take the Place of Manual Cataract Surgery

The role of lasers in the removal of cataracts is beginning to unfold in the United States. Femtosecond lasers have been used in ophthalmic surgery since 2001, and in the late 2000s, work began on their use in cataract surgery.

In 2008, the first laser-assisted cataract surgery was performed in Hungary. After gaining FDA approval, the first laser-assisted cataract surgery was performed in the United States in 2010. Since that time, it has been gaining acceptance and popularity.

The laser does not take the place of manual cataract surgery; instead, the laser "assists" in the removal of the cataract. Phacoemulsification is still used to remove the cataract itself.

The laser performs three key steps in the cataract surgery procedure:

  1. the corneal incisions
  2. opening of the capsule containing the cataract
  3. the initial sectioning of the cataract into smaller pieces.

It performs these three steps with incredible precision, and it is this aspect that may prove it to be superior to the current technique in which these steps are manually performed by the surgeon. The laser can also be used to make incisions in the cornea to treat certain types and amounts of astigmatism.

Further data and well-designed studies are needed to prove that this method is associated with better outcomes and fewer complications than phacoemulsification alone, and much work is being done on this front.

Because insurance does not cover the cost of having laser-assisted cataract surgery, patients are required to contribute a significant out-of-pocket payment. It is important to discuss with your physician what type of procedure would be best for you.

Additional Information about Cataracts


Topics:
Medical Updates
Cataracts
Readers Want to Know

Meet Dan Roberts, Developer of the "LowViz Guide" Indoor Wayfinding Application

Dan Roberts facing the viewer wearing a suit and tie

Dan Roberts, M.M.E., is the Founding Director of MD Support, Inc. and the International Low Vision Support Group. He is the editor-in-chief of Living Well with Low Vision, an extensive online resource center affiliated with Prevent Blindness.

In addition to heading MD Support and the International Low Vision Support Group, Dan is a resource consultant for the Macular Degeneration Foundation and AMD Alliance International. He is also a member of the Working Group on Pharmaceutical Safety.

Dan is the author of The First Year—Age-Related Macular Degeneration: An Essential Guide for the Newly Diagnosed and a contributing author to Occupational Therapy Interventions for Adults with Low Vision. He has also written over 100 articles about low vision and several books specifically designed to bring the resources of the Internet to thousands of otherwise unconnected people with visual impairment.

Dan is the recipient of the 2004 Distinguished Service Award presented by the American Optometric Association, and his organization was awarded the National Eye Institute's 2006 Healthy Vision Community Award for innovative approaches to vision-related health education.

Most recently, Dan is the developer of LowViz Guide, an indoor wayfinding application (or app) that enables users who are blind or have low vision to navigate large meeting spaces, via a smart phone with voice activation. LowViz Guide is a guided assistance program, created specifically for visually impaired attendees at state and national conferences.

Maureen Duffy: Hello Dan. It's an honor to have you with us. To begin, can you tell us more about the LowViz Guide app? What are the features that make it specific to blind and low vision users?

Dan Roberts: LowViz Guide is similar to a portable GPS, but it is useable indoors, where access to satellites, Internet, and cell service may not be available. Using a smart phone or tablet with VoiceOver, the user can audibly "look around" the venue, no matter where he or she is standing, and then call up directions and routing assistance to any point of interest.

The user can also:

  • personalize when, how, and how much information is given,
  • search points of interest and get directions directly to them,
  • choose metric or imperial measurement settings,
  • choose cardinal or clock face direction settings.

MD: Can you tell us more about the development process? And what was your role as the LowViz Guide developer?

DR: Liz Trauernicht, director of MD Foundation, saw a need for a guided assistance program at low vision conferences, so she asked me if I could research the possibilities. I accepted the challenge and, after several weeks of research, decided that the new Bluetooth low energy wayfinding technology was the answer. I contracted with Indoo.rs, a wayfinding technology company based in Vienna, Austria, to design an app that would not only audibly describe the unique indoor environments of low vision conferences, but would also help the attendees navigate to each point of interest with ease and accuracy.

Our concept required a setup that would not be based in any one given location, since the events would be in different places each time. Location information is transmitted by small electronic beacons that we install about 60 to 120 feet apart throughout the entire venue. Concession areas, exhibit areas, meeting rooms, registration tables, restrooms, escalators, and elevators are all customized to the host's specifications and mapped out by me in advance.

Photo of the LowViz Guide app

Photos of the LowViz Guide displayed on an iPhone screen. Source: MD Support

The app identifies the locations both visually and vocally through the user's Apple iPhone or iPad bundled with Bluetooth 4 capability. Anybody with a current Apple iDevice will now be able to navigate these large and often-confusing venues independently, and we are hoping that LowViz Guide will provide a safer and more enjoyable experience for all who attend these functions.

The app and our on-location service and support are free of charge to qualifying organizations. And that's why it's very important for me to say that none of this would have been possible without the vision, enthusiasm, and very generous financial investment of Liz and her MD Foundation.

MD: How is LowViz Guide specifically applicable to conference attendees? Does the app have other uses, too?

DR: LowViz Guide is unique, so you won't find it duplicated anywhere else. We have refined the technology of indoor mapping specifically to assist blind and low vision users at temporary events like seminars and conferences.

In addition to visual mapping, it uses VoiceOver and audible tone routing, and it is customized to the particular layout, features, and time frame of each event. These functions are too precise and short-term to be useful in more general environments, so, in its current embodiment, it is useful only at – and during – the event for which it is customized.

You will, however, continue to see indoor wayfinding technology on a broader scale in venues like hospitals, transportation hubs, amusement parks, museums, and shopping centers. My hope is that most of them will include audible descriptions and routing, because that would definitely level the playing field for people who are visually impaired.

MD: What are your plans for further development of the LowViz Guide?

DR: After this summer's pilot program, we will assess the areas where improvements might be made. This would include more refined routing, like directions to, and descriptions of, specific vendors' booths. We are also surveying the public demand for Android capability.

My biggest concern right now is how to satisfy the demand for this service. Right now, I am personally providing it for six state and national conventions through October. If the service continues to be as successful as our recent launch at the National ADA Symposium, I will not be able to handle the demand on my own. It's a problem I don't mind having, but it is obviously going to require a larger infrastructure.

MD: Where can our readers get more information about LowViz Guide?

DR: You can find everything on the MD Support website at www.mdsupport.org/audioguide. My contact information is there for any organizations interested in making LowViz Guide part of their event. If anyone would like to see it in action, we will be at this year's conventions of the American Council of the Blind, Blinded Veterans Association, California Council of the Blind, Guide Dogs for the Blind, and Pennsylvania Council of the Blind.

We thank Dan Roberts for his support of VisionAware, as well as for his unceasing and longstanding support for quality services for blind and visually persons throughout the United States.


Topics:
Web Accessibility
Assistive Technology
In the News
Online Tools
Technology
Getting Around

Healthy Eating with Diabetes: Part 3 in a Series

Audrey Demmitt and her dog guide

Audrey Demmitt, RN, BSN, is a nurse diabetic educator, VisionAware Peer Advisor, AFB Career Connect mentor, and author of the VisionAware multi-part blog series on diabetes and diabetes education. At age 25, Audrey was diagnosed with retinitis pigmentosa and continued to work as a nurse for 30 years with her visual impairment.

She has worked as an Adjustment to Blindness Counselor and Diabetic Educator for Vision Rehabilitation Services of Georgia and as a school nurse providing in-service training for school staff and developing care plans for newly-diagnosed students and their families.

In Part 1 of her series, Audrey discussed how diabetes education can help lower your blood sugars and reduce the risk of diabetic retinopathy. In Part 2, she emphasized the significance of the A1c test in the effective diagnosis, treatment, and management of diabetes.

In this month's installment, Audrey discusses the importance and benefits of healthy eating as part of a comprehensive diabetes care plan. According to Audrey, "All of us can make improvements toward healthier eating. Start by setting an achievable goal and make a step-by-step plan. Your sustained efforts will pay off!"

The Benefits of Healthy Eating

Everyone benefits from healthy eating, which can sometimes be a challenge – but it does not require special foods or elaborate diet plans. Often, when someone is diagnosed with diabetes, they can feel overwhelmed by the recommended dietary changes, monitoring, and meal planning that are required. While it is very important to pay attention to what you eat, when you eat, and how much you eat, healthy eating can become a positive and enjoyable habit with many benefits.

To make healthy changes in your current eating habits, you may want to begin to record food intake in a daily log so you can see patterns and "trouble spots." Research shows that those who do this are more successful in achieving their dietary goals. Think about what improvements you need to make and set some goals. Keep in mind that the overall goal is to eat the right types of foods at the right times and in the right amounts for you in order to maintain healthy blood sugars, a healthy heart, and optimal body weight.

Please note: For personalized instruction on setting goals and making meal plans, be sure to consult with a registered dietitian, nutritionist, or diabetic educator recommended by your doctor.

Healthy Eating: Some General Guidelines

Here are some general guidelines to help you improve your eating habits when you have diabetes:

  1. Eat a variety of foods from all food groups in the forms which are closest to their natural states. This ensures that you are getting the optimal nutrition and quality of nutrients. Eat whole grains and fresh fruits and vegetables for a fiber- and vitamin-rich diet. For example, choose old-fashioned oats instead of instant oatmeal, which contains extra ingredients including sugar. Eat an apple or an orange for more fiber and nutrients than you get in applesauce or orange juice. Eat a variety of "food colors" for a variety of nutrients.

  2. Avoid processed and packaged foods, which tend to be high in sugar, sodium, fats, and carbohydrates. Shop mainly in the outside perimeter of the grocery store where you will find fresh produce, dairy, and meats. These foods provide the best nutrition for your food dollar. Packaged foods are often more expensive and provide less nutrition than whole, fresh foods.

  3. When planning a meal, consider using the My Plate or Create Your Plate methods. Make ½ your plate fresh veggies, such as steamed broccoli and a salad. Choose a healthy whole grain or carbohydrate source, such as potatoes, whole wheat pasta, or quinoa for ¼ of your plate. And ¼ of your plate can be a protein source, such as lean meat, egg, or beans. To fill out your meal, add a low-fat dairy serving, such as eight ounces of skim milk and a fruit for dessert.

  4. Eat about the same amount of food at each meal and at the same times of the day. This helps your medications and your body regulate blood sugars more evenly. Eating regularly and in consistent amounts can also prevent severe highs and lows in blood glucose levels. Don't skip meals.

  5. Remember that carbohydrates are found in starchy foods as well as sweet foods. Starchy foods include cereal, rice, tortillas, potatoes, bread, pasta, and some vegetables like corn, beans, and peas. Foods and beverages that contain natural or added sugars like fruits, juices, soft drinks, candy, and desserts are high in carbohydrates. Carbs provide fuel for energy and are necessary – but in moderation and measured amounts. Learn what foods have carbohydrates so you can monitor the amount you eat. Think of your daily intake of carbohydrates as an "allowance" and try to spend your allowance on the healthiest of foods, such as a whole grain English muffin instead of a brownie.

  6. Choose complex carbohydrates that are high in fiber. Starchy and sugary foods that are highly processed (white flour, pasta, rice, donuts, candy, soft drinks) break down quickly and become simple sugars, which cause blood sugars to spike. When you choose more complex carbohydrates, such as whole grains (oats, whole wheat pasta, brown rice, beans) and fiber-rich fruits, the body has to go through additional steps to break them down so they do not raise the blood sugar levels as quickly. In addition, you will get the added benefits of fiber from complex carbohydrates. There may be times when you want a fast-acting carbohydrate to raise your blood sugar quickly, but choose complex carbs most of the time.

  7. Choose foods with healthy fats for a healthy heart. People with diabetes are at higher risk for heart disease. Keeping your cholesterol levels down can reduce the risk of heart attacks and strokes. Eat more mono- and polyunsaturated fats, including omega-3s to protect your heart. These fats are found in foods like nuts, canola and olive oil, avocados, salmon, tuna, and peanut butter. Avoid saturated fats and trans fats found in baked goods, crackers, chips, processed meats, butter, high-fat dairy, lard, and coconut oil. These fats raise your cholesterol levels. All fats are high in calories, so be careful with the amounts you consume. When possible, substitute healthy fats for unhealthy fats. You can learn more about heart-healthy eating from the American Heart Association Nutrition Center.

  8. It is important to learn about portion sizes and control them. Often, our portion sensor is "out of whack" and we lose touch with healthy portion sizes. Limiting the amount you eat is a great first step toward managing blood sugars and body weight. This can be done by weighing and measuring your food, following the recommended "serving sizes" on food labels, and using a divided plate as a food guide. A simple ½ cup measuring scoop can be an invaluable tool for learning what typical portions look like on your plate. For instance, one serving of many starchy, whole grain foods is ½ cup, which contains 15 grams of carbohydrates as a rule of thumb. Portion sizes matter. You can learn more about "portion distortion" at the American Diabetes Association website.

  9. Smart snacking can be healthy. Snack foods are usually high in salt, sugar, and fats. Healthy snacks can curb your appetite, boost your energy, and raise your blood sugar when needed. There are many healthy snack options, such as fresh cut-up veggies with low-fat dressing; a small apple with two tablespoons of peanut butter; or two tablespoons of hummus with 10 whole wheat crackers. Healthy snacking can be a way to add additional servings of fruits and veggies or other nutrients you may be lacking. You can learn more about healthy snacks at the American Diabetes Association website.

  10. Learn to read food labels to guide your food choices. Food labels contain important information about serving size, calories, total carbs, total fats, and the amounts of other nutrients and additives. For example, look for whole grain cereals that have 26 or fewer total carbohydrates per serving. You can learn more about food labels at the American Diabetes Association and the American Heart Association.

  11. Counting carbohydrates can improve your blood sugar management. This is another meal planning technique that can help you keep tighter control on your eating, weight, and blood sugars. It requires reading food labels and learning the carbohydrate content of foods in order to balance meals with medications and physical activity. With practice, this can become second nature. Consult your health care team to learn how many carbohydrates per meal are right for you. You can learn more about carbohydrate counting at the American Diabetes Association website.

  12. Set yourself up for success when making changes. All of us can make improvements toward healthier eating. Start by setting an achievable goal and make a step-by-step plan. Start with small steps and reward yourself for your successes. Your sustained efforts will pay off!

Also on VisionAware


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Health
Diabetes and diabetic retinopathy
Education

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