Real partners in diabetes care

Excerpted from page 5 of the November-December 2018 edition of AOA Focus.

In Alabama, where I have been practicing optometry for 30 years, diabetes mellitus (known colloquially as "sugar" diabetes in the South) is as common as grits.

In fact, Alabama regularly ranks among the top states for rates of diabetes cases. Unlike a college football poll, this is not a category in which you want to rank in the top 10. So it's not surprising that a high number of the patients who come into my office are diabetic, though diabetes is a disease affecting our entire nation.

Many of these patients come in with no previous diagnosis of diabetes, just a chief complaint of a sudden change in their vision (a 2 diopter hyperopia or even sometimes a myopic shift is not uncommon), and they may even occasionally have some direct signs, such as microaneurysms in their macula. Far too often, many of these patients haven't seen their primary care physician in a while and may not even remember their doctor's name.

Other patients do know they have diabetes, due to a diagnosis somewhere along the line. But they have not followed up with a health care provider and neglected to do what it takes to manage their condition with appropriate medication, exercise and diet.

Whatever the case, doctors of optometry have a tremendous opportunity to make a real difference to the health of these Americans. In 2017, for instance, doctors of optometry amazingly diagnosed more than 401,000 cases of diabetic retinopathy in patients who did not even know they had diabetes, an estimation based on a survey of 67% of doctors of optometry.

Imagine, then, the incredible impact doctors of optometry could make if we were more aggressively integrated into taking care of these patients. How would that look? We could initiate care on the spot, rather than refer them on to another primary care physician and risk them not following up after they leave our offices. We, along with their primary care physician, would be real partners in managing their care, educating and encouraging their self-care. We would be more involved in getting the appropriate lab work and then share the results with patients and their primary care physicians. The AOA offers great resources on diabetes in AOA Marketplace, including updated patient education pamphlets. Also, the AOA's Evidence-Based Optometry Committee is currently updating the clinical practice guideline Eye Care of the Patient with Diabetes Mellitus, which should be completed in the coming months.

Although we are experts on the vision system, this integration requires that doctors of optometry not only get the training and education they need to serve their patients as primary care physicians, but also to take greater responsibility for their patients' diabetes care. No more assuming the patient's diabetes is the problem of another primary care physician.

If we can diagnose diabetes, why shouldn't we have a greater hand in the treatment?

We should.