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Slideshows

Catch up on the top stories in optometry during the week of August 18-August 22.

Takeaways from this week in optometry: August 18 - August 22

Articles

The DOT lens has now been launched across Asia-Pacific, Europe, and North America, with an estimated 500,000 fitted with DOT lenses in 2025 alone.

DOT lenses for slowing myopia progression worn by a total of 1 million children

The acquisition focuses on LayerBio's OcuRing-K technology, with plans to initiate the next clinical trial.

PainReform acquires majority equity interest in LayerBio

Researchers found that patients with primary open-angle glaucoma have less agmatine and thiamine in the aqueous humor than patients without glaucoma.

Molecules in aqueous humor may lead to biomarker discovery for glaucoma, according to study

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Dr. Jay M. Haynie is an adjunct clinical professor at Pacific University College of Optometry, a Fellow of the American Academy of Optometry and a member of the Optometric Retina Society. He is a published author and has become a nationally recognized speaker on advances in technology and the management of retinal disease.



OYE Technology

Dr. Kerry Gelb speaks with Dr. Jay M. Hainie in the second part of their discussion on diabetes of the eye! 

Open your eyes: diabetes of the eye (part 2)

In the first of a two-part installment, Dr. Gelb speaks with Dr. Jay M. Haynie on diabetes of the eye.

Dr. Haynie is an adjunct clinical professor at Pacific University College of Optometry, fellow of the American Academy of Optometry, and a member of the Optometric Retina Society. He is a published author and has become a nationally recognized speaker on advances in technology and the management of retinal disease.

Open your eyes: diabetes of the eye

The committee will work to help the organization increase awareness and early identification of diabetes-related eye diseases, improve access to eye care treatment, policy development, research, and surveillance.

Prevent Blindness implements Diabetes + the Eyes Advisory Committee to combat diabetes-related eye diseases

Data used in the post hoc analysis were from 56 parameters from 4 testing modalities obtained in a multicenter US trial (NCT03197870).

Study finds electroretinography/pupillometry as strongest predictor of DR progression, vision-threatening complications

The first-in-class, twice-daily topical formulation is intended for the treatment of nonproliferative diabetic retinopathy and diabetic macular edema. 

Exonate plans to initiate phase 2b CLEAR-DE trial for EXN407 topical formulation for NPDR

What we should be telling our patients about the remission of type 2 diabetes with weight loss.

How much is enough? Seeking remission from type 2 diabetes

Nicholas R. Green, OD, FAAO, gave a presentation on the management and treatment of diabetes and its ocular effects at the American Optometric Association’s Optometry’s Meeting 2025 in Minneapolis, Minnesota.

AOA 2025: What role do optometrists play in the diabetic pandemic?

From contact lens dropout to addressing diabetic retinopathy in rural communities, optometrists choose an area of eye care research that they would expand, given the appropriate resources.

Brainstorming eye care research expansion with unlimited resources

In discussing areas of eye care research that optometrists would prioritize if they had unlimited resources, several key themes emerge. Dry eye and anterior segment diseases are a major focus for Shane Kannarr, OD, who sees a high prevalence of these conditions in their clinic. He is also particularly interested in finding ways to prevent vision loss from early diabetic retinopathy, which is common in the rural community they serve. Early intervention is seen as crucial for managing these serious eye health issues. 

Andrew D. Pucker, OD, PhD, FAAO Dipl, FSLS, FBCLA, is passionate about understanding and reducing contact lens dropout, which affects around 20% of patients annually. They believe that more research in this area could help keep people in contact lenses longer, benefiting both patients and the overall market. The potential of genetic research in healthcare is also discussed. 

Erin Rueff, OD, PhD, FAAO notes the challenges of identifying rare conditions and the need for larger, more diverse patient populations in studies. She is particularly interested in better understanding the genetic factors behind corneal disorders and how that could inform clinical practice. Improving minority representation in clinical trials is highlighted as a key priority. 

Mark Bullimore, MCOptom, PhD, emphasizes the importance of ensuring research results are generalizable to the entire US population, rather than being skewed by underrepresentation of certain groups. 

Finally, there is a focus on advancing ocular surface disease research, including improvements to diagnostic tools, treatment options, and data analysis, per Bridgitte Shen Lee, OD, FAAO, FBCLA, FEAOO. She advocates for faster, more accurate data collection, as well as the use of artificial intelligence and big data to provide clinicians with real-world insights on treatment outcomes. 

Overall, optometrists have revealed a range of pressing research needs in eye care, from specific disease areas to broader issues of equity and innovation in clinical studies and patient care.

Videos

According to A. Paul Chous, MA, OD, FAAO, optometrists have an important opportunity to educate patients in their chairs about diabetes.

AAOpt 2024: Key takeaways from the 2024 diabetes update

A. Paul Chous, MA, OD, FAAO, provides some takeaways from the "Diabetes Update: What's New in 2024" presentation given at the American Academy of Optometry meeting. 

Editor's note: The below transcript has been lightly edited for clarity.

Do any pearls or advice for optometrists who are maybe starting to see an uptick in patients with diabetes in their chairs?

Yeah, so the first thing, it's such an important question. It's really the foundational question, right, how do we prevent people from getting diabetes? I've only got a single slide on this, but essentially, there was a big analysis conducted looking at delaying the diagnosis of type 2 diabetes by even 4 years. That results in about a 35% risk reduction in dying from a major adverse cardiovascular event. So even though diabetes prevention, long term, most people with pre diabetes, people that are at high risk for getting type 2 diabetes, eventually they get diabetes. But the bottom line is, if you can delay the onset, you can improve people's longevity and hopefully their quality of life. The other pearl is just to ask patients about what medications they're on. And I know this is a common experience in eye care, ophthalmology and optometry. You know, what meds are you on, they tell you metformin or one of these other agents. And so patients, a lot of times, don't even reveal or know that they've been diagnosed with diabetes. So you want to ask specifically about medications. If possible, look at the EMR and look at their blood glucose values and the like. I really think that optometry specifically, generally spends more time with our patients, educating them, so I think we can play a pivotal role as diabetes educators, and can help our patients with newly diagnosed diabetes do a better job, because that's when tight blood sugar control makes the most difference, is that if you get it early on. If you wait for the horse to be out of the barn, as I say all the time, therapies aimed at lowering blood sugar and even blood pressure are not as beneficial. So you want to get these folks on with a program that's going to lower the risk for retinopathy early on, but also to the extent we can prevent type 2 diabetes in the first place. It's going to have huge public health impacts over the coming decades.

Absolutely. And if you could boil it down to a few key takeaways that you really want to drive home to optometrists, what would they be?

Optometrists already served as diabetes educators par excellence, and I want us to continue down that road. I think the more we know about diabetes treatments, the better we are able to counsel our patients in an appropriate way. Gotta remember always to communicate with the primary care physicians. They're overwhelmed with diabetes care, they're seeing so many patients, and I'm an advocate for – there's been talk from the Academy of Family Practice to have non-endocrinologists, non-internal medicine healthcare providers, get a diabetes certification credential that would allow us to educate but also perhaps prescribed medications for patients with newly diagnosed diabetes. And I think this is something that optometrists would be very good at, very adept at incorporating this, perhaps into our daily practice. We need all hands on deck because of the epidemic of diabetes and prediabetes.

Yeah, that would be very, very interesting if that came to fruition.

Thank you again, Dr Chous, for sharing this update on diabetes for 2024. It's been a very fascinating conversation, and I really appreciate you taking the time.

Emily, it's my pleasure, as always. Be well.

Conference

A. Paul Chous, MA, OD, FAAO, details a presentation on this year's updates on diabetes given at this year's Academy meeting.

AAOpt 2024: Racial and socioeconomic disparities in diabetic eye disease

Paul Chous, MA, OD, FAAO, overviews a presentation he gave at the 2024 American Academy of Optometry meeting alongside Jeffry Gerson, OD, FAAO. Chous explains that the presentation will focus on several key updates in diabetes care, including a greater emphasis on racial and socioeconomic disparities in diabetic eye disease. One major topic is the impact of glucagon-like peptide-1 receptor agonist medications, which are commonly used for weight loss and type 2 diabetes management. Chous notes that while these drugs have shown benefits like reduced sleep apnea and dementia risk, there are also concerns that they may worsen diabetic retinopathy in some patients, particularly those who experience rapid improvements in blood glucose levels. The presentation also covered emerging therapies for diabetic retinopathy, including the use of electroretinography to monitor disease progression, as well as potential oral medications and gene therapies that may help slow the worsening of diabetic eye disease. 

Additionally, Chous discussed the importance of cardiovascular and renal protection for patients with diabetes, as these comorbidities are often more life-threatening than vision loss. He emphasizes that optometrists should be familiar with these broader diabetes management strategies, as they can impact ocular health. Overall, the presentation aims to provide optometrists with a comprehensive update on the rapidly evolving landscape of diabetes care, with a focus on identifying high-risk patients, utilizing new diagnostic tools, and understanding emerging treatment options that can help preserve vision and overall health for individuals living with diabetes.

Mohammad Rafieetary, OD, FAAO, FORS, Dipl ABO, ABCMO, discusses diagnostic confusion that can be encountered when identifying macular edema in patients.

AAOpt 2024: Mastering macular edema

Mohammad Rafieetary, OD, FAAO, FORS, Dipl ABO, ABCMO:

Hello everybody, friends and colleagues. Mohammad Rafieetary here, and I'm optometrist at the Charles Retina Institute in West Tennessee, East Arkansas, North Mississippi. We are here in Indianapolis for the American Academy of Optometry meeting 2024 and my presentation was"Mastering Macular Edema: Eitologies, Diagnosis, and Management." As we all know, a lot of retinal related vision loss affects the macula and in maculur spectrum disease, many of these are caused by changes in the edema that is caused by fluid flux. You know, whether it's diabetic retinopathy, diabetic macular edema, retinal vein occlusion, macular edema, even in context of neovascular AMD, there is fluid flux into the macula. We don't necessarily call that macular edema. We call that in with reference of subretinal or intraretinal fluid. And they are also conditions that are really not macular edema. They may masquerade, you know, things like foveoschisis. It looks like pockets of fluid, but these are schisis pockets. So to go through the spectrum of these diseases, to explain, "What is swelling? What is edema? What is leakage?" These are all different things. They mayassociate with each other. You could have somebody who's got macular edema and no longer leakage. The leakage that caused the edema has stopped. And leakage is a term we use a lot of times, looking at OCT which is wrong, because leakage is an angiographic finding. So I went through a lot of this stuff, had some clinical examples, and it was a good lecture, I think. I think the audience enjoyed it, and I hope to be back next year to present something else here at the Academy.
So as far as things that are confusing to clinicians, because we use, for the most part, we use OCT to evaluate patients for macular edema, whether it is a patients with diabetic retinopathy or a patient with macular degeneration. Again, the gray areas are not distinguished between edema and leakage, not to distinguish between swelling and edema. You could have a patient with an epiretinal membrane whose retina has swelled up is increased in thickness, volume. But that's not necessarily edema, nor is it leakage. So I went through some of these again, demonstrated some OCTs, some angiography. A demonstrated case of diabetics, for instance, that one retina was extremely swollen with fluid, but the angiography leakage of it was actually less than the fellow eye that had some degree of edema under OCT, not only the OCT topography, but the OCT tomography didn't show much of a fluid, but that actually leaked more. So sometimes the leakage and the drainage of that leakage, or processing of the leakage, could cause diagnostic dilemmas and diagnostic confusion.

Dr. Jeffry Gerson talks about new developments in diabetes diagnostics and treatments

AAOpt 2024: What to know about this year's diabetes update

Alongside Paul Chous, OD, FAAO, Jeffry Gerson, OD, FAAO, picked over literature published in the last 12 to 18 months to provide an update on new developments in diabetes eye care for this year's American Academy of Optometry (AAO) meeting in Indianapolis, Indiana.

Hi everyone. I'm here today with Dr Jeffry Gerson of Grin Eye Care in Kansas. He's here to chat about his presentation, "Diabetes Update: What's New in 2024," that he gave at this year's AAO meeting in Indianapolis, Indiana. So welcome. It's a pleasure to have you here today.

No, thank you very much for having me. Excited to tell you about the talk.

Of course, we're excited too. So first, would you be able to give an overview of your presentation?

Yeah, you know, I think the way I would start an overview is that this is a talk that I was able to do with my really good friend and colleague, Dr Paul Chous, and he and I have been doing basically the same title talk for more than 15 years now for the Academy of Optometry, which makes it sound like we keep doing the same thing, but the name of the talk is "Diabetes Update," and it's completely new every year. So really what we do every year is we look at published literature over the last 12 to 18 months and pick out little gems that we think are important, both in the world of diabetes and in diabetes eye care. So that's the gist of what we talk about.

Awesome. So what were some of those gems this year?

Yeah, so this year, we chose to talk a little bit about the GLP-1 drugs and how they work systemically, and whether we do or don't need to worry about them when it comes to our patients' eyes. You know, actually not from literature, but talked a little bit about the direct to consumer campaigns that we see some of the drug companies currently doing that are focused on both diabetes and macular degeneration. And then just talked about some of the other new both eye treatments and systemic treatments and things we've learned over the last 12 months.

Yeah, absolutely. So how does that new information in any type of way change diabetes management on the OD side of care.

That's a really good question, because we want to always make our talks practical, and the way we look at it is, over the course of the hour talk, we probably talk about 20 to 25 different topics, each one pretty briefly, and so our hope is that 1 or 2 of the things we talk about will be something that people will integrate into their daily practice and how they're talking with patients, and maybe another 1 or 2 will just change the way they think about diabetes care. So we know that not everything we talk about will be practical and relevant to everybody, but we're pretty convinced that at least a few of the things that we talked about will be, that everyone will take away something that they can integrate in their practices the next day in clinic.

Absolutely, yeah. So in that, what improvements do you think, for just common eye exams that can potentially make early detection possible, is there any information that had come out this year or anything that you see coming out next year that can help in that early detection?

Yeah so one of the things that we talked about in our talk was early screening for diabetic retinopathy outside of eye care providers' offices, so primary care or endocrinology. The FDA approved a handheld fundus camera that uses cloud-based artificial intelligence to be able to detect more than mild, nonproliferative diabetic retinopathy. So I think this is important because it helps to prioritize referrals to eye care providers. We know and primary care providers know that anybody with diabetes needs an eye exam, but if they're able to screen and detect people that have some significant retinopathy, then that kind of changes the urgency. So that's something that we see changing in helping to get the right people to the right places sooner. And we think that's also a motivator for patients with especially when they know they already have active disease.

Absolutely, yeah. So do you find that there are any treatment options that may be overlooked, either something that's new, or has been proven over a long period of time to be effective?

You know, another one of the things that we talked about is there's an oral medication called Tricor that in other parts of the world has been being used as a treatment for people with diabetic retinopathy to help reduce progression. And the reason we talked about is because it's not being used in the US yet, but there is an ongoing clinical trial that we would encourage people to consider sending patients in for because it's an oral treatment for anyone with NPDR, to try to see if it helps prevent it from progressing. And so I think that's something that could dramatically change the landscape from a number of perspectives, and one of them is that it's an oral medication that's already existing, that we as optometrists could potentially be prescribing to patients, if it becomes more standard of care here in the United States.

Absolutely, yeah. Was there anything else that you wanted to add that we haven't touched on yet?

I think the overarching or general thought that Paul and I really like to get across is that, as optometrists, there's a huge role that we can play in the care for our patients with diabetes, and that we don't need to and probably shouldn't just limit it to how do your eyes look today. And so that's why we think it's important to talk about all these things and a lot of more foundational diabetes information, because ultimately, that's what determines how well your patients will do. And so it's just something that we're really excited to talk about every year. Every year, it's not necessarily tricky, but it's a lot of work to put together and really pick out our favorites from the year. So it's a really fun talk for us to get to.

Jeffry Gerson, OD, FAAO, gave a presentation on what to know about diabetes diagnostic tools and treatment alongside Paul Chous, OD, FAAO.

Mark Dunbar, OD, FAAO, emphasizes the critical role optometrists play in the collaborative care of diabetic eye disease.

EyeCon 2024: Taking a multidisciplinary approach to diabetic eye care

At the EyeCon meeting in Fort Lauderdale, Mark Dunbar, OD, FAAO, of the Bascom Palmer Eye Institute will be presenting on the importance of a multidisciplinary approach to managing diabetes. Joined by diabetes care expert and EyeCon co-chair A. Paul Chous, OD, MA, FAAO, Dunbar will emphasize the critical role optometrists play in this collaborative effort. 

As frontline providers, optometrists are often the first to recognize signs of diabetic retinopathy in their patients. But Dunbar stresses that their responsibilities extend far beyond just identifying eye health issues. "As optometrists, we do a great job of educating our patients on blood sugar levels, diet, and exercise—things that are typically part of primary care," he explains. 

The key, according to Dunbar, is maintaining open lines of communication with the other healthcare providers involved in a patient's diabetes management, including endocrinologists, primary care physicians, nurse practitioners, and physician assistants. "We're in the middle, and our job is to relay information back and forth—what we're seeing in the eyes, and what the primary care team is telling the patient about controlling their diabetes," said Dunbar. 

Dunbar notes that building these collaborative relationships, especially for young optometrists starting their practices, can be challenging. Patients may have difficulty accessing specialists or be limited by their insurance coverage. But he believes it's a critical step, as primary care providers are actively seeking optometrists they can trust as resources for their diabetic patients. In his EyeCon presentation, Dunbar plans to share practical tips for optometrists, such as the key questions to ask new diabetic patients to assess their level of disease management and engagement. He'll also discuss strategies for helping patients navigate the complexities of the healthcare system, drawing on the expertise of his co-presenter Chous. By fostering a true multidisciplinary approach, Dunbar is confident optometrists can play an invaluable role in improving outcomes for the millions of Americans living with diabetes. Attendees of the EyeCon meeting will come away with a roadmap for strengthening these vital partnerships.

Rafieetary emphasizes the importance of follow-ups and consistent support to prevent patients from dropping out of treatment.

AOA 2024: How to support patients who are receiving intravitreal injections

In this interview, Mohammad Rafieetary, OD, FAAO, discusses his American Optometric Association (AOA) lecture titled, "Through the eye of the needle," which focuses on the experiences of patients receiving eye injections for retinal diseases. The lecture is interactive, featuring a panel including Jessica Haynes, OD, FAAO, FORS, and Roya Attar, OD, MBA, FAAO. They aim to provide insights into the challenges faced by patients, including transportation, insurance, and emotional stress, and offer advice to referring optometrists on supporting these patients. The lecture seeks to address "injection fatigue" and other logistical issues to ensure patients continue their necessary treatments.

 This transcript has been lightly edited for clarity.

Hello, everybody, I'm Mohammad Rafieetary. I'm an optometrist. I practice at the Charles Retina Institute. We have a multi-physician, multi-clinic, retina specialty practice that covers basically west Tennessee, north Mississippi, and east Arkansas. I'm here at the AOA, have [to wear] many hats at the AOA. I'm on the Education Committee. I'm giving lectures here. I'm sitting in some lectures.

But the one lecture I'm very, very, very excited about is called, "Through the eye of the needle." I have about an hour interview with other optometric colleagues, retina specialists, and particularly a lot of patients that are going through the experience of receiving injections in their eyes for a variety of retinal diseases. And we often, you know, the colleagues who refer these patients to a place like my practice where it's a retina only practice, they don't really get the sense of what these patients go through [during] their journey of, you know, we explain this stuff to them, they get injections, they have to come back frequently. They get exhausted, they have a lot of issues from transportation, insurance coverage. So we tried to cover this and this is a very, very interactive lecture. I have two colleagues, Dr. Jessica Haynes that works with me actually at the Charles Retina Institute, and Dr. Roya Attar, who's actually at the University of Mississippi Medical Center in Jackson, Mississippi. I have them as a panel of experts, for us to be able to engage the audience. I hope you can make it to that lecture. I'm excited to see you all there.

There are a couple of advices I can give to the colleagues who refer patients to retina practices where the patients may end up being a frequent flyer. One is to make sure you always have a followup plan for your patient in your practice. One is to give that support and explain to these patients that are being managed for a chronic disease. So basically, [be] like a cheerleader to make sure that patients don't drop off treatment because dropping out of treatments often ends up in poor prognosis, and none of us want that for our patients.

Right now, one of the biggest challenges we face in this group of patients where they receive frequent injections, there is something called an injection fatigue, they don't want to go through this, there is a lot of logistics. Again, they have transportation issues, they have to have caregivers bring them, and the anxiety of what they go through because you tell somebody you're going to stick a needle in their eye, you know, you can get 200 different responses from the patients. So we try to calm the patients down, reassure them, you know, support them again so they continue with their chronic disease treatment and management.

Rafieetary emphasizes the importance of follow-up plans and consistent support to prevent patients from dropping out of treatment, which can negatively impact their prognosis.

Bryan Wilson, PhD, MBA, details the reason Birmingham, Alabama was chosen to be the location for a manuscript on African Americans and diabetic eye disease

Deciding on Birmingham as the site of ADA, Genentech's diabetic eye disease manuscipt

The American Journal of Accountable Care 

works to investigate and overview the disproportionate risk that African American Alabamians have in developing diabetes, as well as identify the 4 main pillars of barriers that keeps this population from accessing eye care. Bryan Wilson, PhD, MBA, executive director medical affairs at Genentech, details the decision behind choosing Birmingham, Alabama as the site of the manuscript and what this means for future research.

Learn more about the details of the manuscript 

- This transcript has been edited for clarity.

So the ADA and the Genentech community, we've been on the grounda nd we've been working so hard. Just to give you a flavor of the impact we've had over last year, so we've actually held over 51 eye screening events across the Alabama community and we've had over 85 community activations. The Open Your Eyes campaign was 1 of the largest that was associated with the Magic City Classic, which is an annual football event that happens in Birmingham every year. We reached over 4000 community members. And so it gets to the point that I made earlier: we're in the community and we want to co-create with the community, so that 4000 member community engagement shows our commitment to that. It shows that we are co-creating with the community mind in mind, as I like to say, and it's just been a real pleasure to see the impact and seeing folks become activated around diabetic eye health.

Was the location of the optometry school at (University of Alabama at Birmingham, or) UAB part of the decision to put the study in Birmingham?

It wasn't an initial deciding factor. It was actually a plus that it's there. Yes, we want partners, both academically and within the clinical community, and we were blessed to have that within Birmingham. So yes, having an optometry school there, having passionate people on the grounds, like I mentioned, a few like Janene Sims, Edmund Arthur, these individuals are passionate, they're there, they're doing the work. And so yes, it's not a key selection criteria but it is a bonus and it is a plus, that we can co-create with these creative individuals. So it's just been great working with them. Both of them were involved in our Diabetic Eye summit and both have been heavily involved in some of the work and strategies that we've been co-creating. In addition to primary care physicians, internal medicine physicians like Andrew Sherrington, who have been instrumental in the implementation of our quality improvement work and some of our local evidence generation activities to truly understand health system barriers. Because yes, there's a community component, but there's also a health system component that also plays a big role in sustaining the work. And so it's been great to work with all of them.

Is part of how you decided on Birmingham, does that have anything to do with its history of the city?

Yes, so the city of Birmingham is just a magical place and a place of opportunity. But it's also a place where the civil rights movement had significant headwinds in the 1960s and earlier than that, even. And so what that means is that because Birmingham was such a pillar in the civil rights movement, it really allows for an opportunity for the reshaping of how we think about civil rights and what that means for people and people having access to good health, access to economic development, access to the American dream, if you think about it. When I think about what that means and how we fast forward now to 2024 and how we're implementing innovative health measures, implementing health partnerships like this with the ADA and Genentech, I couldn't be more pleased. And it's definitely aligned with the spirit of the Birmingham community to change the paradigm of how things are with the understanding that because that's the way things are (and with respect to diabetes, with the high rates of diabetes in Alabama,) it doesn't have to stay like that, not just in Alabama or Birmingham, that that's something that we can do together to change things. And so for me, as an African American male supporting this work, that's really important that I remember that whatever I see, we have the power to change, but we have to also work with the community to co-create real-life, honest, and relevant strategies with the community in mind. And so I'm really excited to be able to support this. I'm really excited about the ADA and Genentech partnership, and I'm really even more excited about what this can mean for the Alabama community and beyond.

Bryan Wilson, executive director of medical affairs at Genentech, details why Birmingham, Alabama was chosen as the community to study the effects of diabetic eye disease among African Americans in a new manuscript from the ADA and Genentech.

Deciding on Birmingham as site of ADA, Genentech's diabetic eye disease manuscript

Bryan Wilson, PhD, MBA, speaks on Black Alabamians' increased risk for diabetes and correlated eye diseases, talks community partnerships

Manuscript outlines increased risk of diabetic eye disease in Black Alabamians, encourages community collaboration 

works to investigate and overview the disproportionate risk that African American Alabamians have in developing diabetes, as well as identify the 4 main pillars of barriers that keeps this population from accessing eye care. Bryan Wilson, PhD, MBA, executive director medical affairs at Genentech, speaks on the article as a collaboration between Genentech and the American Diabetes Association's (ADA) Health Equality Now initiative. 

. Those interested in Health Equity Now can learn more 

Hi everyone. I'm here with Bryan Wilson, executive director of medical affairs at Genentech, who is here on behalf of the ADA Genentech Health Equity Now partnership to talk about the findings regarding the burden of diabetic eye disease in Alabama, as well as strategies that target racial health disparities within that population. These findings are recently published in the Journal of Accountable Care. So welcome. It's really great to have you here.

Of course. So first, can you tell us a little bit about the findings that were just published?

So it's great to be back and see you again. And yes, the Breaking Barriers manuscript is our research review article that highlights an important public health problem across Alabama. We know that diabetes continues to be a really big issue across Alabama. And it's not specifically an Alabama problem, it's a US problem. But the comorbidities associated, 1 of the premier comorbidities associated with diabetes, is diabetic eye failure or diabetic eye health. And so this manuscript truly highlights the barriers that patients face, that health systems face, in tackling diabetic eye health and improving those outcomes. And like I said, it's not just an Alabama problem, but we hope that the barriers that we highlight can shed light on areas that everyone can highlight and tackle in the various parts of the US.

So this investigation was undertaken in Alabama. Can you tell me more about why the team chose to focus on that population?

Absolutely, so Alabama is a unique opportunity and a thriving community. But what we see in Alabama is the diabetes rates are higher compared to the rest of the nation. So the prevalence of diabetes in Alabama is around 13%. And that's fairly high, so when we think about that from a numbers standpoint, about 500,000 people are battling diabetes across Alabama. And that state's population is not nearly as high as some of your metro cities in the US. So when we think about this, that creates a huge burden on health systems.

Now, as I mentioned before, 1 of the comorbidities associated with uncontrolled diabetes and poor diabetes outcomes is negative diabetic eye health. And so we specifically chose Alabama because of that reason. Now, we also realized that certain populations, specifically African American populations, Hispanic populations, are impacted disproportionately with diabetes. We know that the population of African Americans across Alabama, it's about 27%, compared to the national average, which is around 12%. So we not only have a state where the African American community is high compared to the nation, but we also have a disparity of diabetes outcomes that disproportionately impacts this population. So we specifically chose Alabama for that reason to tailor interventions that take the community health in mind, while also tackling a really important health problem that many patients are facing.

Yeah, absolutely. That makes it a very interesting case study. Do you think you can explain a little bit about how you think that these findings will extrapolate to other populations across the US?

Diabetes is not an Alabama-centric problem, it's a national problem. It's actually a global problem. And we know that the comorbidities that are associated with uncontrolled diabetes are things like diabetic eye health, cardiac dysfunction, metabolic dysfunction, and also folks ability to live a vibrant, agile life. So when we look at these barriers, some of the ones that we highlight specifically in the review manuscripts are socioeconomic barriers, patients' awareness and access to eye screenings, whether a patient truly understands the importance of that initial, that first eyes screening is incredibly important. Also, a third barrier is tailoring educational materials to the patient's education level and to their cultural level as well. Those are some of the barriers that we know patients are facing.

Then also we highlight some of the barriers that are present within health systems. So if patients present really advanced stage diabetic retinopathy or really advanced stages of diabetic eye disease, can they get referred in the right way? Can they get referred in the proper and efficient manner to get connected to advanced care? And so we know that these barriers are not just syndrich to Alabama, but these barriers are national and global issues.

I also would like to mention, the review manuscript also highlights the work and that's incredibly important when companies like Genentech come into these communities. It's really important for us to highlight the work and not necessarily reinvent the wheel, but we align to the work that's already occurring and we co-create together. And so we hope that by co-creating with the Alabama community that we can create a case study and a case that this should be modeled across the nation and in other communities as well.

Yeah, that's beautiful. That's so cool. So I also understand that the paper outlines 4 barriers to equitable eye care, which you just laid out beautifully. Can you tell me a little bit more about how these pillars will shape future recommendations and actions by the ADA Genentech Health Equity Now partnership?

So the American Diabetes Association, they actually have diabetic eye health guidelines that gives patients, providers, and any member of the healthcare community that is caring for these patients, it gives them a framework for how 1 can go about treating a patient that may present with diabetic eye disease. We highlight that in the article as well. Why that's important is because guideline-directed therapy is a mainstay. It's vetted by the academic community and the clinical community and so we wanted to align to that. It sustains the work because we're not just operating in a silo. So we're not just coming into the Alabama community and implementing measures, strategies that are not aligned to where the clinical community is already going, nor are these strategies outside and are not aligned to where the ADA feels that patient care should be going. So that creates a great pathway to sustainability. It allows us to maintain trust with the scientific and clinical community and it's also allowing us to co-create strategies that are vetted and scientifically proven, so that again helps to scale the work for if you're moving into another community, and if you're trying to apply to a different disease state.

Yeah, absolutely. So looking at those pillars that you guys have outlined, 2 in particular really stick out to me as calls to action for optometrists, which are lack of awareness and the importance of eye exams among people with diabetes and limited access to eye care. In your dream world, how would you like to see the optometric community respond to these limitations?

I love to the dream, so dreaming is incredibly important. And let's just highlight that the optometry community across Alabama, this is something that is a priority for them. There are great folks on the ground, Janene Sims at (University of Alabama at Birmingham, or) UAB, that are leading the charge, Edmund Arthur at UAB, great, brilliant optometrists that are leading the charge on these efforts, both from a scientific standpoint, and from a clinical standpoint. These optometrists are going out in the community, they're identifying adults, and older adults as well. We know that diabetic eye disease is starting to actually impact younger adults. And so that is something in my dream world that I would like to see more of as well, identifying those younger adults, maybe in the 35 to 45 age range, that are battling uncontrolled diabetes, and are honestly suffering from the complications of diabetic eye health.

And so with all of that in mind, my dream world is to see that work continue, to see not just not Genentech having a seat at the table, but multiple organizations, multiple companies that are taking and putting their equity stake in the game to tackle this problem. It's really important because it's not so much about trying to do something different or trying to reinvent the wheel. It's really about aligning to the work and finding ways to enhance that work and we already know that the optometry community in Alabama is doing that. So in my dream world, my goal will be to see that enhance, to see that optometry community have what the need: advanced resources, newer technologies to detect diabetic eye disease faster, and then create pathways to referrals in case those patients have advanced eye disease.

Yeah, absolutely. I mean, public health is a group project and we all got to put in the work to make it happen, so definitely aligned on your dream world I'd like live in it.

So many of these barriers to care are heavily influenced by racial inequity. How is the Health Equity Now partnership helping Black patients with diabetes gain better access to care, and what should the rest of the community be doing to help support these efforts?

Absolutely. It's an important question and we know historically in these communities, and Alabama specifically, it's a unique community because when we think about health care in Alabama, we cannot forget the Tuskegee trials. We know that ramifications of that and how that has infused mistrust amongst the community, specifically the Black community. So it's very important that we co-create with the community so if we are creating resources, whether they be educational in nature, if we're implementing some form of a quality improvement process within a health system, it's very important that we think about the cultural ramifications and the socioeconomic ramifications of these specific communities. And I'm specifically talking about the Black community, African American community, since that's the question that you asked. It's important that we tailor interventions with the community in mind and we have to make sure that we are aligning relevant and intentional strategies and resources. That's the only way that we're going to sustain the work. It's going to allow us to earn the trust of the community and when these things are over, the community is still in a great position to continue that work, and so awareness is key.

We actually hosted last year, a diabetic eye summit and it highlighted a number of different barriers and perceptions in how community members view their health. And so in that session, in that summit, we were able to debunk and shed light on and also expound upon how patients can be empowered, how they can have a broader understanding of their disease process, so that they can take ownership for the future. So those are some of the ways that we want to sustain the work, but also create impact in the African American community.

Yeah, that's really beautiful. Thanks for sharing that. Is there a way for members of the optometric community to get involved in the Health Equity Now program?

The manuscript, "Breaking Barriers: Partnerships to Improve Diabetic Eye Health in Alabama," highlights the burden of diabetic eye disease in Alabama, as well as strategies that target racial health disparities within that population.

Diabetic Eye Disease

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