What’s your clinical protocol for managing diabetic retinopathy?

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According to recent projections, by 2060, nearly 18% of US adults (60.6 million) will have diabetes.¹ That number is currently 38.4 million.² Twenty-six percent of them have diabetic retinopathy (DR).³ What’s more, all of those patients are at risk of developing vision-threatening diabetic retinopathy and diabetic macular edema.³ By 2050, the prevalence of DR is predicted to nearly triple⁴ and, without treatment, the patients with high-risk proliferative DR have a 50% chance of becoming blind within 5 years.³ These figures are concerning and have made me question what I can do to make a difference for the patients who rely on me for primary eye care services.

As I reflected on this while brainstorming with colleagues, I found a group of like-minded leaders in optometry who shared my passion to make a real difference. Together, we formed a task force. The group unanimously agreed that there are unmet needs in diabetic eye care that our profession is uniquely suited to fill. So, we set out with a goal to elevate the standard of care. However, we remain sensitive to the fact that most of our colleagues practice in busy environments, like my own, that can make change difficult. With that in mind, we knew we needed to create a plan that would be practical to implement.

After nearly a year of development, our group of 14 clinicians released a consensus document titled “Modern Fundamentals of Diabetic Retinopathy Management in Optometry.” We believe that this framework will radically simplify DR management so optometrists can confidently care for the growing population of patients with diabetes. Importantly, the guidelines are based on 5 pillars, all of which are backed by evidence-based science. We distributed these for the first time at the 2023 American Academy of Optometry meeting in New Orleans, Louisiana, in October. The support we’ve received has been overwhelmingly positive, but we believe that it is important to solicit feedback from the entire optometric community.

To achieve this, we’ve developed a survey so optometrists can vote on whether they support specific elements of the new guidelines, as listed below. We also have included write-in response areas for comments. We believe this is an important next step in erasing the unmet needs in diabetic eye care. Optometry is at the forefront of this effort, and it is the goal of the task force to ensure that everyone’s voice is heard so a diversity of views are represented and considered as we move forward.

On behalf of my colleagues on the task force, I invite you to take this survey. We look forward to keeping you abreast of the results as we collaborate to erase avoidable blindness due to diabetic retinopathy.

The 5 Pillars of Diabetic Retinopathy Management in Optometry

Detect: Approach diabetic retinopathy as a chronic progressive disease. Being a chronic progressive disease implies that you can detect it before it becomes an advanced disease. This can be achieved using both structural and functional testing.

Grade: Grade diabetic retinopathy at the time of diagnosis and at each subsequent visit. Chart structural retinal damage and quantify retinal cell function.

Assess risk: To assess risk of progression, monitor diabetic retinopathy patients over time using both structural and objective functional measures.

Manage: Utilize multidisciplinary resources to manage all diabetic retinopathy patients, regardless of disease severity.

Support: Provide comprehensive patient education and strategies to help prevent disease progression.

References

1. Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018;16(1):9. doi:10.1186/s12963-018-0166-4

2. National Diabetes Statistics Report. Updated November 29, 203. Accessed January 9, 2024. https://www.cdc.gov/diabetes/data/statistics-report/

3. Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of diabetic retinopathy in the US in 2021. JAMA Ophthalmol. 2023;141(8):747-754. doi:10.1001/jamaophthalmol.2023.2289

4. Saaddine JB, Honeycutt AA, Narayan KMV, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126(12):1740-1747. doi:10.1001/archopht.126.12.1740