AAOpt 2022: The OD's role in addressing silent killers

Sherrol A. Reynolds, OD, FAAO, director of the Retina Clinic and Chief of Primary Care at Nova Southeastern University College of Optometry, as well as past president of the National Optometric Association, speaks with Optometry Times®' Kassi Jackson on highlights from her discussion titled, "The OD's role in addressing silent killers: diabetes, hypertension, and dyslipidemia," which she presented during the 2022 American Academy of Optometry (AAOpt) annual meeting in San Diego.

Editor's note: This transcript has been edited for clarity.

Jackson:

Hi everyone. I'm Kassi Jackson with Optometry Times, and I'm joined today by Dr. Sherrol Reynolds, director of the retina clinic and chief of primary care at Nova Southeastern University College of Optometry, as well as past president of the National Optometric Association.

She's here to share highlights from her discussion titled, "The OD's role in addressing silent killers: diabetes, hypertension, and dyslipidemia," which she is presenting during the 2022 American Academy of Optometry meeting held this year in San Diego. Thank you for being here. Dr. Reynolds.

Reynolds:

Thank you so much for having me.

Jackson:

Absolutely. Would you please share with us the key takeaways from your presentation?

Reynolds:

So the key takeaways from this presentation ...

Number 1 is that these conditions: diabetes, hypertension, and dyslipidemia—or hypercholesterolemia—are increasing in prevalence, and especially in the patients that we serve. And so it's important to share this information. And not only that, that we as eye care practitioners—optometrists—we're on the front line of diagnosing patients with these diseases; oftentimes, these diseases go undiagnosed.

As you know, high blood pressure—or hypertension—is called the silent killers. There are very few symptoms with hypertension until it's very, very high, or it causes more underlying systemic complications. In fact, when we look at the increase in prevalence of these conditions, for example, diabetes, we're seeing in 2022, that 133 million Americans now have diabetes. And that's really important. And what's more important, is that that number includes 96 million people who have pre-diabetes. These are individuals that have elevated blood sugar levels, but they're not high enough yet to be treated; they're on the road to developing full-blown, type 2 diabetes.

And because we're seeing an increase in the number of our patients that have diabetes, we're also seeing an increase in the prevalence of diabetes-related eye disease or complications. For example, we know that patients with diabetes are up to 60% more likely to develop cataracts. We also knew that patients are 20% more likely to develop glaucoma. And more importantly, we also know as eye care practitioners that vision is important.

Remember, patients with diabetes can have good vision, or 20/20 vision and have significant diabetes-related retinal disease or complications, such as diabetic retinopathy, or diabetic maculopathy. So again, as optometrists, we serve on the forefront of not only diagnosing patients with underlying type 2 diabetes in most of the cases, but detecting these early complications earlier, so that treatment can be initiated earlier, so that we can preserve sight.

When it comes to high blood pressure it's the same thing. We're seeing an increase; 116 million people now have hypertension. And most of that has to do with the new guidelines that were published about a year or 2 ago, when it comes to hypertension.

The new definition of hypertension is anyone that has a blood pressure of 130 over 80 or greater, these individuals are more at risk and need to be treated. So it used to be 140 over 90, so that now with these numbers, we're seeing more and more individuals. And that's important, because you have earlier detection. And with a new definition you can implement whether it's lifestyle changes for these patients, but also to intervene earlier to prevent underlying complications.

And what's important for optometrists to also note is that these early signs that we see from high blood pressure in the eyes—these arteria venous crossing changes—those are significant and they can predict a patient's stroke risk, right? So it's important to educate our patients, not only about the significant signs, but also the early signs and preventing complications.

When it comes to hypercholesterolemia—dyslipidemia—the same thing, we're seeing an increase in patients that have high cholesterol, have high lipids, are at elevated triglyceride values, and at the ocular complication, there's sometimes—at earliest—signs of the underlying systemic disease.

So my goal is to educate my peers about the increased prevalence of these conditions. And just to remind my peers that it's so important that we play an important role in diagnosing and preventing severe complications from these diseases.

And I will share that as past president of the National Optometric Association, an organization dedicated to advancing the visual health and minority population, that these conditions are profoundly more prevalent—or significantly more prevalent—in minority communities.

So it's really even more important as an optometrist, when we have our patients and, you know, our patient population is changing, is becoming more diverse, that we talk to our patients about these conditions to make sure that our patients get the follow-up medical care that they need.

Jackson:

Great. And what does that mean for patient care for optometrists to be able to understand these risks, assess and provides that care, early intervention?

Reynolds:

I think 1 of the key things is also patient education, right? So as eye care practitioners, we're part of the healthcare team. And a lot of these patients, as I mentioned earlier, are undiagnosed. And we as optometrists, through the eye exam and dilated comprehensive eye exams, are the first doctor that detect these underlying changes that could potentially save that person's life. And so it's important that we educate our patients about the condition.

And I think it's also important that we follow up and intervene early. I think patient communication with the other members of the healthcare team is important as optometrists, it's important to share the results of the eye exam for patients with diabetes. Sometimes medication can be changed or augmented to increase based on the eye finding same thing with high blood pressure, if an optometrist sees these early signs, educates the patient on the importance of a yearly comprehensive eye exam.

The key thing is to educate the patient on the importance of compliance to their medication. A lot of times, you know, when we look at hypertension, 50% of patients don't even have it well-controlled. They don't take their medication; again, it's because it's a symptomless disease.

As part of the healthcare team, optometrists play a key role in educating the patient and increasing awareness that these diseases can impact the eyes and can potentially lead to vision threatening changes such as vascular occlusion; and more importantly, to follow these patients with a yearly comprehensive eye exam, or more frequently, if they have complications such as hemorrhages or bleeding, and appropriate referral for these patients.

Jackson:

Dr. Reynolds, thank you so much for your time today.

Reynolds:

Thank you so much for having me.