Diabetes is a disease process that affects more than 30 million Americans. Diabetic retinopathy is the leading cause of vision loss in the 25- to 74-year-old population, and this presents a great opportunity to optometrists, not only to provide early detection but also to initiate treatment when indicated.
DIAGNOSING THE DISEASE
Undiagnosed diabetic patients may present to our offices with a wide array of symptoms ranging from asymptomatic to atypical shifts in refractive error to cataract formation to signs of diabetic retinopathy. An atypical shift in refractive error will prompt us to rule out diabetes as the etiology. Signs of diabetic retinopathy, such as microaneurysms, hemorrhages, cotton wool spots, venous beading, intraretinal microvascular anomalies, macular edema or neovascularization would also prompt us to rule out diabetes.
Once diabetes is diagnosed these patients should receive an annual eye exam to monitor for diabetic retinopathy along with other problems more prevalent in diabetic patients such as cataracts, glaucoma, dry eyes and oculomotor problems.
Diabetic retinopathy is classified into nonproliferative and proliferative with varying stages in each category. Our patients may be asymptomatic until late in the disease process so it is important for us to educate them about the importance of annual exams to allow for early detection and treatment if indicated. Symptoms that may occur include blurred vision, difficulty with night vision, floaters or dark spots in the central vision. This also presents an opportunity for us to discuss the importance of glucose control through diet management, exercise, medication and smoking cessation.
MANAGING THE CONDITION
Diabetes is a disease that lets us interact with the primary care providers and endocrinologists regarding our patients’ healthcare. This can help these providers in determining whether diabetes control is adequate and initiate additional treatment when indicated. Diabetes is a disease process that gives optometry the opportunity to be part of the healthcare team for this population.
Diabetic retinopathy can be a frightening diagnosis, but it provides optometrists an opportunity to build a trusting relationship with patients. This includes education about the importance of annual eye exams to provide for early detection and ongoing monitoring of the signs and symptoms. Think About Your Eyes (TAYE), the public awareness campaign for the vision industry, also encourages patients to get annual eye exams to better serve the diabetic population. Together with TAYE, we can continue to be advocates for our patient’s vision health.