Diabetic Eye Disease

Before the new year gets too far along, let’s take a brief look at the happenings in the pages of Optometry Times during 2016.

Effectively manage patients through diagnosis and interpretation

A 37-year-old male came to my office for the first time in 2014 for a diabetes eye examination at the insistence of his primary-care provider (PCP).

Eyecare practitioners who deal with patients in the perioperative period are well aware of the need for topical therapy. In most cases, a combination of a steroid, a nonsteroidal anti-inflammatory drug (NSAID), and an antibiotic will be used for a few days before the day of surgery and then for a period afterward.

We had better wake up fast to address this multifactorial problem.

In the city of Chicago, there’s a 95-year-old retired pathologist and professor with a wry smile on his face. More than 50 years ago, Joseph Kraft, MD, identified that many tinnitus patients were in fact pre-diabetic.1 Back then this was a leaner America, and far fewer citizens had diabetes. Of course, much has radically changed.

We all know the typical algorithm for our patients having diabetes: Maintain healthy blood sugar and pressure control, get annual dilated eye examinations, and receive laser or anti-VEGF therapy if and when they develop vision-threatening diabetic retinopathy (DR).

Mass media and medical publications have been warning for years that the incidence of diabetes is rising rapidly and predicting a “health catastrophe” in which more than 10 percent of the U.S. population would be living with this disease.

Many of your patients are interested in maintaining or improving their vision, but they may walk into your office with wrong information.

Fifty years of dietary guidelines have emphasized “low fat” and “low cholesterol” eating, so manufacturers obliged by creating foods with increasing sugar and wheat/gluten content while promoting exercise and widespread use of statins to lower cholesterol. Yet Americans have become overweight, obese, and typically less healthy at an alarming rate. The newest 2015-2020 U.S. dietary guidelines, eighth edition, are attempting to address this issue by limiting “added sugar.”1

A new study recently published in Retina found that communication between a diabetic patient’s eyecare provider (ECP) and primary care physicians (PCPs) increased the likelihood that the patient would make and keep her eye exam appointment.

From new ways of predicting who will and won’t develop diabetes, to new diabetes meds, to new evidence regarding which anti-vascular endothelial growth factor (VEGF) might be better for your specific patient, the last year has given us better tools for helping our patients with diabetes.

Paul Chous, OD, MA, and his scientific team, as published in a recent British Journal of Ophthalmology clinical scientific study, have just raised the bar for public service, professional practice, and fiscal responsibility.

Recently, a colleague wrote me to express his concern about a primary care physician (PCP) in his community acquiring digital retinal photographs of his diabetes patients. One of those patients presented to the optometrist’s office with the impression that “all he needed was a refraction” since the PCP had “already checked him for diabetic retinopathy.”

Many diabetics neglect their eyecare due to not knowing and/or misunderstanding the effects of diabetes to the eyes and visual system. Much of the inadequacies in patient education can be attributed to the absence or insufficient communication among healthcare providers, including optometrists, and our patients.

A 76-year-old white female presented for her periodic diabetic eye examination at UAB Eye Care in July 2014. She admitted to blurry vision in her left eye for approximately one week.

According to the National Eye Institute (NEI), 7.7 million people age 40 and older have diabetic retinopathy, and this number is projected to increase to approximately 11 million people by 2030.

During the American Academy of Optometry's Academy 2014, presenters shared how optometrists can help halt the diabetes epidemic and combat associated ocular complications.

Researchers at National Taiwan University Hospital have developed a wearable optical device that can detect sluggish pupil reaction, a symptom of diabetic autonomic neuropathy.

Big optic nerves make me feel good. I find them easier to evaluate, and I don’t get as worked up about their respective big optic cups.

A study recently published in Diabetes Care found that methazolamide (Neptazane, Fera) significantly lowered HbA1C levels in patients with type 2 diabetes.

A study recently published in Diabetes found that corneal confocal microscopy and skin biopsy could detect early loss of small nerve fibers in patients recently diagnosed with type-2 diabetes.

Researchers from the Indiana University School of Optometry have detected early warning signs of potential diabetes-related vision loss.

iHealth has launched a glucose monitor for iPhone and Android smartphones. According to the company, iHealth Align is the world’s smallest and most portable mobile glucometer.

A cataract is a clouding of the crystalline lens, resulting in vision loss. There are different types of cataracts, and they may be associated with underlying conditions. Understanding the differences between types of cataracts will improve clinical management of your patients.

A recent study found that metformin (Glumetza, Salix), a popular diabetes drug, is associated with a dose-dependent risk reduction for open-angle glaucoma.

I sometimes wonder why, in the rush to build the medical model, so many of my colleagues seemingly abandon the retail aspects of our profession. Many ODs seem to want to forget or diminish that our historical contribution to vision has been mainly centered around the correction, refractive, and binocular vision function and development.

After more than 2 years of work, the American Optometric Association (AOA) has released Eye Care of the Patient with Diabetes Mellitus, an evidence-based guideline to help ODs care for patients with diabetes.

An Internet-based screening approach performs well in identifying patients with treatable diabetic eye disease, according to a study in Optometry and Vision Science.

A study presented by Freedom Meditech President and COO Keith Ignotz at SECO found that measurements of lens autoflurescence can distinguish patients with diabetes from those without.