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Carrying the Torch of Diabetic Eye Care and Research

Throughout the month of August, we will be sharing important milestones from Joslin’s rich history. More than a century after its creation, Joslin continues its legacy as an internationally recognized diabetes treatment and research institution. This month we are celebrating the talented and dedicated individuals who have contributed to and continue to focus on our mission of preventing, treating and curing diabetes.

Dr. Lloyd M. Aiello (left) with his son, Dr. Lloyd P. Aiello, holding a picture of Dr. William Beetham
Dr. Lloyd M. Aiello (left) with his son, Dr. Lloyd P. Aiello, holding a picture of Dr. William Beetham
To be a pioneer in medicine is a rare distinction. To have a family with three generations of pioneers — each making quantum leaps in eye research and care — is even more extraordinary.

Joslin has such a family. Beginning with William P. Beetham, M.D., the torch of diabetes eye research and care has been carried by his son-in-law Lloyd M. Aiello, M.D., and grandson Lloyd Paul Aiello, M.D., Ph.D. Collectively, they are responsible for pioneering novel techniques that have dramatically reduced vision loss from diabetes. Today, the average vision for Joslin patients is 20/20.

In the past, blindness was common. “With the discovery of insulin, diabetes became a disease you could live with,” says Dr. L.M. Aiello. “But over time, high glucose levels can damage blood vessels in the eye, heart and kidneys. In 1952, if patients had proliferative diabetic retinopathy, they often had other widespread vascular damage. Their chance of dying within five years was 73 percent.”

With the advent of the ruby laser, Dr. Beetham had a revolutionary idea. In proliferative (advanced) diabetic retinopathy, blood vessels grow where they don’t belong. Perhaps this invasive growth could be stopped by making thousands of pinpoint “burns” in the back of the eye on the retina. Assisted by Dr. L.M. Aiello, the first panretinal laser procedure was performed in 1967. It worked. Basically, the eye continues to see by “summating” vision across the tiny cauterized areas.

Patients flocked to Joslin in droves. Dr. L.M. Aiello recalls caring for 90 patients per day, from 6 a.m. to 11:30 p.m. The procedure soon was tested in a nationwide clinical study, and for more than 40 years has been the treatment standard for proliferative diabetic retinopathy. Recognizing diabetes patients in other parts of the world also need proper eye screenings and care, in 1998 he was instrumental in creating the cutting-edge Joslin Vision Network. In this high-tech approach, detailed retinal images are taken elsewhere, such as Venezuela, then transmitted to Joslin, where eye experts evaluate them and send back a treatment plan.

Another eye problem can occur with diabetes—macular edema. In this condition, blood vessels leak, causing swelling in the macula, the retinal area responsible for sharpest vision. Dr. L.P. Aiello, who heads the world-renowned Beetham Eye Institute named for his grandfather, recently pioneered a way to stop this swelling, using a drug injected into the vitreous of the eye to stop a growth factor that commonly causes this problem. Today this therapy is the international treatment standard. On the horizon, he is developing noninvasive technologies to detect and study real-time functional and structural changes in the diabetic eye, perhaps allowing even earlier intervention.

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