|The California from Optos provides more than 80% or 200Ëš of the retina in a single capture.|
Retinal imaging tools assist with detection, patient education and disease management.
A large majority of the diabetic population is unaware of the risk factors associated with the disease and the major implications they may cause to ocular health. It is our job to make these facts known to our patients and to outline a detailed plan with the use of new technology to manage and detect changes in our patients with diabetes.
A key aspect of managing these patients is to know their medical history, risk factors for progression of diabetic retinopathy and the status of their glucose control. The HbA1c provides us with a three-month average of blood sugar control as a better prognosticator for blood sugar control than any daily personal monitoring of blood sugar. The test results can be ordered with a blood panel and are often already done a few times a year for established patients with diabetes.
In a patient with poor glucose control, small caliber blood vessels can be damaged, specifically the pericytes lining the endothelium of a blood vessel wall, which cause the blood vessels to lose their integrity and leak at the blood-retinal barrier. Fortunately, there are several lifestyle modifications that can help prevent diabetic retinopathy from progressing into a proliferative stage.
In our office, we utilize retinal OCT scans and fundus photography to view structural integrity of the retina at annual visits, or sooner depending on severity. For retinal imaging, we use medical screening Optos images to photo-document and quantify any presence of retinopathy and to use as a baseline when judging progression. The images link directly to a computer monitor in each exam lane for review and patient education.
It is also imperative to monitor the macular area for any presence of edema secondary to leakage of blood vessels, so we perform a Macular Thickness scan with a Cirrus HD-OCT 5000 series to detect any clinically significant macular edema. If there is any further suspicion of macular edema from those scans, or from the best correctable visual acuity, we can further test for presence of diabetic macular edema by performing a 5 line HD Raster OCT scan of the macula to evaluate the presence of any cystic spaces from blood vessel leakage. As the standard of care, any presence of retinopathy in either eye indicates a dilated fundus exam.
CO-MANAGING THE DISEASE
A great way to continue to expand the scope of optometry, and increase the merit of our profession, is by co-managing patients with diabetes by communicationg the results of each diabetic evaluation to their medical care providers. This creates relationships between medical professions and leads to better management and care of our patients.
Technology has simplified monitoring the ocular health of people with diabetes by having the ability to reference stored data from each previous visit at the click of a mouse. As the incidence of the disease continues to grow and evolve, we must continue to push the limits of what we are able to do in the management and care of our patients.
Katherine Shen, OD, is an associate at Specialty Eyecare Group in Seattle and Kirkland, WA. Charlie Ronan is a fourth-year student at Indiana University interning at Specialty Eyecare Group.