ocular histoplasmosis

[lena505]

I have just been diagnosed with ocular histoplasmosis in my left eye. (I cannot see any of the chart but I can see that outline ) My opthamologist has set me on a course of injections in my eye. (lucentis) Luckily my insurance covers it.  Because this is new to me, I would like to ask several questions.  Can I continue my exercise program with this?  I am a type one diabetic and need to exercise.  
What are the possible ways that I could have been subjected to this spore.  I live in an area where there are lots of fresh water lakes.  I'm an elementary school teacher.
Since the remaining vision in my left eye seems to interfere with the way that I focus on things, is it safe for me to wear an eye patch on my left eye while I'm at work?  

Anxious to hear!

lena505

[John C Hagan III, MD, FACS, FAAO]

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[dukey]

Avastin is not approved anywhere for intraoccular injection but many insurance companies pay for it anyway. I know mine did but I have no idea what the office actually told them!

Well it sounds like you have had a good work-up done so you can probably be confident of your diagnosis. If you have had type 1 diabetes recently diagnosed, you are correct in ruling out retinopathy; it seems very unlikely. Whilst studies have shown that your blood sugar does not have to be to high for very long for complications to occur, it sounds like yours is under good control. If you keep your HbA1c as close to 6.5% as possible, you should be fine.

As a side note on your diabetes, you should consider having GAD, ICA and IAA antibody tests done. You may have latent autoimmune diabetes in adults (LADA). Your description seems almost classic for LADA, especially your C-peptide levels. Ask your doc about LADA or type 1.5 diabetes.  

[John C Hagan III, MD, FACS, FAAO]

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[lena505]

Thanks for your reply.  I had a clear bill of health for any signs of diabetic retinopathy on March 3rd, 2009.  This was done by my local optician.  On March 28th, I woke up not seeing properly and went to emergency.  The emergency doctor gave me a general workup and connected me to an opthamalogist (and eye surgeon) who met me at another hospital on March 29th.  He did a complete set of tests and wanted me back the next day for a flurostan scan. ( I think that's the way you spell it, its the one with the dye)  He showed me the pictures the next day and where the histo spots were.

I would have been surprised if it were diabetic retinopathy since I have only been diagnosed with type one diabetes since 2006.  It was strange because I was 55.  I presented at the hospital with classic signs, no history of diabetes in the family and no problems with weight.  The c petide test clinched it. I was told that as long as a followed the three musts, insulin, diet and exercise, I should not have any problems for years as long as I control my sugars which I have done. (not so badly)

I have though about the switch to Avastin but I need to check with my medical insurance company.  The Ontario government has not yet approved it for this eye procedure. Only Luncentis has a DIN #.

I am concerned about my immune system however since as far as I know the diabetes was caused by this, earlier I had Hashimoto and am hypothyroid.  Now I have an opportunist disease that attacks people with weakened immune systems. I am hoping to see my physician and ask for a referral to a specialist to find out whether the fungul infection is still in my body.

Thanks again, any other advice is appreciated.

[John C Hagan III, MD, FACS, FAAO]

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[dukey]

Get off Lucentis and insist on Avastin. Same thing, huge difference in price. As a side note, POHS is a difficult diagnosis. Have other more common things been ruled out (retinopathy springs to mind)?

[John C Hagan III, MD, FACS, FAAO]

1. Ask your surgeon about activity
2. In the Midwest over 50% of us have been exposed to histo generally by breathing in the spores from dust size contaminated soil. Same mechanism elsewhere but less common fewer chicken, birds and other histo hosts.
3. As your surgeon

JCH MD