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I am a Vietnam veteran who was exposed to Agent Orange. As a result, I have diabetes, peripheral neuropathy, and was recently diagnosed with glaucoma in both eyes. None of my family has suffered from these disorders. I have been told that there are studies linking glaucoma and diabetes, and was wondering if this was the case. If so, is the research available to the public? The reason for asking is that my Veteran Service Officer would file for additional benefits if we can produce what is called a "Nexus Letter," which I presume is a written doctor's opinion. Thank you!

First, thank you. As the son of a Vietnam veteran and the grandson of a WWII veteran, I have a great admiration for all of the men and women who have served our country.

Currently, the VA recognizes the following conditions as being related to Agent Orange exposure:

  • Acute and Subacute Peripheral Neuropathy
  • AL Amyloidosis, Chloracne (or Similar Acneform Disease)
  • Chronic Lymphocytic Leukemia and Other Chronic B Cell Leukemias
  • Diabetes Mellitus (Type 2)
  • Hodgkin's Disease
  • Ischemic Heart Disease
  • Multiple Myeloma
  • Non-Hodgkin's Lymphoma
  • Parkinson's Disease
  • Porphyria Cutanea Tarda
  • Prostate Cancer
  • Respiratory Cancers
  • Soft Tissue Sarcoma (other than Osteosarcoma)
  • Chondrosarcoma
  • Kaposi's sarcoma
  • Mesothelioma

Some new associations are being examined currently, but no ruling has been made to my knowledge. To date, I do not believe that the VA recognizes that Agent Orange exposure is a primary cause of glaucoma. Your question pertains to whether or not patients with type 2 diabetes (which is recognized by the VA) is an independent risk factor for glaucoma (hence a possible connection). There are several studies that do support this conclusion, but they are slightly controversial. In general, the more often a patient goes to the eye doctor the more often the doctor can examine the eyes and catch glaucoma if it is present. It is possible that because patients with diabetes go to the eye doctor more often (to have their eyes dilated for diabetic eye exams); their doctors are seeing them more often and can make the diagnosis more often. The problem with glaucoma is that approximately ½ of the people that have glaucoma do not know it because they do not go to the eye doctor for regular eye exams. For your benefit, I have included references to the three primary studies that argue for a connection between diabetes and glaucoma. They were all published in the medical journal "Ophthalmology" hence they are available to the public.

  • P. Mitchell, W. Smith, T. Chey and P.R. Healey, Open-angle glaucoma and diabetes: the Blue Mountains Eye Study, Australia, Ophthalmology 104 (1997), pp. 712–718
  • L.R. Pasquale, J.H. Kang and J.E. Manson et al., Prospective study of type 2 diabetes mellitus and risk of primary open-angle glaucoma in women, Ophthalmology 113 (2006), pp. 1081–1086
  • B.E. Klein, R. Klein and S.C. Jensen, Open-angle glaucoma and older-onset diabetes: the Beaver Dam Eye Study, Ophthalmology 101 (1994), pp. 1173–1177.

I will caution you that these studies are suggestive, but not conclusive of a link between the two. Further, my willingness to provide this information is by no means a physician's written opinion stating that I believe that the connection exists. If asked, I would have to say that the evidence is suggestive but not conclusive for the reasons I stated above. At this time, there is no definitive evidence proving a connection. It is possible that a connection exists, but we just don't have the data to support it conclusively quite yet. We are still looking and hopefully that information will be available in the near future. I wish you the best of luck.

Posted 06 Nov 2010


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