Diabetic Eye Disease

Patients with diabetes may need to add a dry eye workup to their health assessments. Scott Schwartz, OD, from Detroit, MI, discusses his poster, “Does diabetes make a difference in dry eye,” at ARVO 2018 in Honolulu.

ODs may wish to incorporate color vision testing when working with patients having diabetes. A. Paul Chous, MA, OD, FAAO, CDE, talks about the importance of these tests, incorporating them into day-to-day exams, and devices available.

Diagnosing and treating diabetic macular edema (DME) can pose a challenge for ODs. A. Paul Chous, OD, MA, FAAO, CDE, examines a case of non-center involved DME and the challenges he faced when treating one patient.

It is important for eyecare providers to be familiar with these new drugs and findings. We often see patients with diabetes, metabolic syndrome, and high CV risk, and we are in a position to help counsel our patients about new treatments-and even suggest that appropriate patients have conversations with their primary-care physicians, endocrinologists and cardiologists.

A 30-year-old female with a 16-year history of insulin-dependent diabetes and no other ocular or systemic conditions developed proliferative retinopathy in March 2015. She had not been closely followed for the previous five years.

Recognize characteristics and stages of macular hole for better pictures

Diabetic retinopathy (DR) in patients is a common finding in optometric practices. When we grade the level of retinopathy, we often do so with findings of the Early Treatment Diabetic Retinopathy Study (ETDRS)in mind.

Let’s examine case-based examples to emphasize the top five neuro-ophthalmic disorders that should not be overlooked.

A colleague recently told me that eye doctors should “stay within the lines” of traditional eye care because we barely have enough time as it is to do our jobs. My response was that today more than half of our adult patients have either diabetes or prediabetes, so our job now requires we go ”outside the lines” to avoid the leading cause of preventable blindness.

Given this abundance of nonhuman species living on and within our bodies, it is not surprising that there is a link between specific bacteria to systemic and ocular disease-including diabetes and diabetes-related eye disease.

OCT is one of the best way to assess patients for the presence of diabetic macular edema (DME)

At this moment, optometric leaders are seemingly wedged between fighting against online refractions and spectacles and fighting for “follow the money/ophthalmologic care.”

Fasting regimens have gained popularity as a technique for reducing weight and obesity. This strategy may improve insulin sensitivity in patients with insulin resistance and diabetes.

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.