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

While diabetic retinopathy is not one of the leading causes of blindness and vision impairment globally, the widespread prevalence of diabetes warrants the need for resources.

Optometrists around the globe have a responsibility promote the allocation of resources for the management and treatment of diabetes and its ocular effects, according to Nicholas R. Green, OD, FAAO. During his presentation “The Diabetic Pandemic: What Optometrists Can Do to Help” at the American Optometric Association’s Optometry’s Meeting 2025 in Minneapolis, Minnesota, Green stated that while diabetic retinopathy (DR) is not one of the leading causes of blindness and vision impairment globally, the widespread prevalence of diabetes warrants the need for resources.¹

According to a study in The Lancet Global Health, cataracts make up 1.28% and uncorrected refractive error makes up 2.05% of causes of blindness and vision loss globally, which Green cited as complications that can be contributed to diabetes.²

“Even though diabetic retinopathy now makes up a very small portion of all the causes of blindness and vision impairment in the world, it can absolutely contribute to cataract as well too,” Green said. “They can contribute to uncorrected refractive error, particularly significant fluctuations in vision, so that makes it a lot more difficult for patients to have glasses that meet their needs and still having issues with that. So I would say absolutely it is still [a global need], not just in high resource areas. It is absolutely worth it to be looking to putting resources into managing patients with diabetes and managing ocular complications.”

Additionally, Green noted that the prevalence diabetes globally is expected to increase dramatically in lower and middle-income countries by 2050, with many of these countries without the medical infrastructure to withstand this increase. With diabetes estimated to contribute a $1.3 trillion economic burden, or 1.8% of the global GDP, the indirect cost of lost income and additional needs for home care leave families in these countries shouldering the economic burden of the disease. Additionally, DR is the number 1 cause of blindness in working-age adults, which puts stress on both local and global labor forces.¹

“If you're getting this disease, you need to be spending all the time in the doctor's office or getting hospitalized,” Green said. “That's more time that you're spending taking care of your own health versus going to work and contributing to your community. In particular, these lower/middle-income countries that really need to have a robust, healthy workforce to really develop their own countries, this can be really a huge problem if there's a single part of their workforce that is spending most her time getting care, or are disabled and unable to work.”

Green said that optometrists can help by discovering undiagnosed diabetes, screening for ocular diabetic complications, managing and preventing blindness, determining health care resource allocation to improve care, and advocating for better diabetic eye care to relevant stakeholders to aid in global care reform.¹ According to a recent global report on DR, approximately 27% of patients with diabetes have reported that they were not educated on the ocular effects and conditions caused by diabetes until they began experiencing them, which underscores the importance of patient education.³

Ways that eye care providers can help patients now to combat the increase of diabetic prevalence is discussing glycemic status with all diabetic patients, delaying prescribing glasses in patients with uncontrolled blood sugar levels, diabetic macular edema, and visually significant diabetic cataracts, perform more frequent posterior segment examinations in patients with DR, and refer patients with other appropriate providers for their condition.¹

“When you have your diabetic patients in your chair, even if they have an A1c of a 6 and their blood sugar is 100 every time they check it, make sure you tell them that these are still possibilities, and to make sure that they're aware of it,” Green said. “At least help them, to motivate them to come in more for their eye exams, and really tell them to become [a larger] part of their own health care, and they can manage it themselves.”

References:

1. Green NR. The Diabetic Pandemic: What Optometrists Can Do to Help. Presented at: Optometry’s Meeting 2025; June 25-28; Minneapolis Minnesota.

2. GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9(2):e144-160. doi:10.1016/S2214-109X(20)30489-7

3. The Diabetic Retinopathy Barometer Report: Global Findings. DR Barometer. Accessed July 1, 2025. https://drbarometer.com/wp-content/uploads/2022/08/drbarometer_global_report-1.pdf