As a practicing optometrist I realized the connection between diabetes and what I do, and decided to enroll in the online Master of Science in Diabetes Education and Management program at Teachers College. During my interactions with classmates, I have learned that diabetes educators in all clinical backgrounds can help people with diabetes take care of their eyes and protect their vision.
Eyesight vs. Eye Health
The eye provides a unique opportunity to monitor microvascular changes. An annual dilated vision exam by an ophthalmologist or optometrist can screen for the occurrence of retinopathy. Early changes are usually reversible with lifestyle (nutrition and activity) and medication interventions. Even in advanced cases (usually treated by laser for retinopathy, intravitreal injections for macular edema or vitreoretinal surgery for more advanced conditions) timely intervention and treatment can prevent further vision loss or blindness. However it has been my experience that many patients (with or without diabetes) correlate eyesight with eye health. The two terms are not equal. A patient may mistakenly carry a false sense of security about eye health. Patients with proliferative retinopathy or macular edema can have excellent acuity (20/20 vision). Undiagnosed these underlying conditions will continue to worsen and by the time a patient notices vision changes fewer treatment options remain. Additionally the risk of vision loss and blindness increases due to the condition itself and/or the treatment required to stop its progression.
Images that compare the different stages of retinopathy to that of a normal retina can be informative. One study indicated that showing the patient their retinal images had a positive impact on patient attitudes toward eye care. However, discretion should be exercised. An educational intervention that uses fear as a motivator for change (in this case continuity of eye care) has been shown to have the opposite effect.
Another helpful tool that can educate your patients on the importance of regular eye care is the web-based Retina Risk calculator (www.retinarisk.com). This tool uses blood pressure (BP), A1C, and diabetes duration to calculate future risk of retinopathy for a specified number of years in the future. It is easy to use on office computers or tablets. The BP and A1C numbers can be adjusted to demonstrate the positive affect of improved self-management skills. This resource is free for the first month, and then has a charge.
Another option might be for your institution, health center or clinic to invest in a retinal camera. This works well in instances where patients are reluctant or unable to engage in yearly comprehensive eye exams due to lack of transportation, age/cognitive change and time constraints. Digital photos without dilation can be taken by non-eye specialists for later review by a qualified clinician/physician.
Loss of vision and blindness are devastating to the individual with diabetes. The few minutes a diabetes educator invests in communicating the importance of regular comprehensive exams may provide a patient with a lifetime of vision and improved quality of life.
Guest blog post by Dr. John McDonald, OD