1. Outlook
Destined for Diabetes
With the disease’s prevalence at epidemic levels, now is our moment to shine.
By Paul M. Karpecki, OD, Chief Clinical Editor
A
merica’s diabetes epidemic,
like its citizens’ waistlines,
is growing. Data from the
2011 National Diabetes Fact Sheet
show that nearly 26 million Americans—8.3% of the population—
have been diagnosed with diabetes.
The prevalence increases by 6.5%
annually, according to some estimates. By the year 2020, one out of
three people over age 65 will have
diabetes; 27% already do.
Worse still is the sobering news
that more than seven million people
suffer from the disease but remain
undiagnosed, and that another
79 million people are considered
pre-diabetic. Among adults, either
manifest or incipient diabetes will
ultimately become more common
than its absence.
This is borne out in our clinics.
Diabetes is the leading cause of new
cases of blindness in US adults. A
little over four million, or 28.5%,
of people with diabetes age 40 or
older had a diagnosis of diabetic
retinopathy, and 4.4% have the
proliferative form.
Literally millions more are waiting for appointments right now.
There are over 100 million eye
exams performed annually (most
commonly by optometrists) but
only about 40 million visits to
primary care providers for annual
check-ups. Unfortunately, many
patients—even those at high risk—
are not compliant with annual
physicals. So, there are at least
twice as many opportunities for us
to diagnose diabetes as there are
for GPs or FPs in the course of one
year. Furthermore, type 2 diabetes occurs when patients are most
likely to seek an eye examination,
which is in the early 40s, around
the age of presbyopia.
It is within our power to dramatically alter the course of diabetic
eye disease, and diabetes itself—a
systemic disease with multi-organ
morbidity that may be first discovered in your chair.
We Set the Pace
This crisis highlights the profound importance of optometry’s
role as the health care providers
who initiate and coordinate diabetes care in collaboration with
endocrinologists, primary care
physicians, retina specialists and
diabetes educators. As we all know,
the only anatomical site where one
can directly examine the human
vasculature is the eye. This gives us
unprecedented opportunity to initiate care for many patients.
Of course, changes in blood
glucose might be identified prior
to any sort of retinopathy, but
improved diagnostic capabilities
are helping optometrists to identify
diabetes even prior to any retinopathy findings and now even prior to
changes in A1C.
New technology that can
measure autofluorescence of the
lens (see this month’s ‘Research
Review,’ page 72) could enhance
our ability to diagnose diabetes
as much as six to seven years in
advance of other clinical manifestations. Furthermore, detecting and
timely treatment of diabetic reti-
16 REVIEW OF OPTOMETRY DECEMBER 15, 2013
nopathy with laser can reduce the
development of neovascularization
by an estimated 50% to 60%. And
the Diabetes Control and Complication Trial showed that earlier
diagnosis with well controlled
blood glucose in patients with type
1 diabetes reduced the incidence of
diabetic retinopathy by more than
75%.
Diabetes patients require an
annual dilated examination; those
diagnosed with nonproliferative
diabetic retinopathy may be seen
every six months to ensure that it
is stable. Progression to proliferative diabetic retinopathy would
then warrant involving the retina
specialist.
In short, we set the pace of
patient care.
Something Old,
Something New
This patient population’s care
requirements also dovetail nicely
with traditional optometry.
Diabetes patients have a higher
risk of glaucoma and greater propensity to develop cataracts prematurely; they also have dry eye in
about 50% of cases, and over twothirds of adults with diabetes and
poor vision have a refractive error
that can be improved with corrective lenses.
Let’s rely on our strengths in
vision and eye health to serve existing diabetes patients’ needs while
embracing our new responsibilities
in not merely primary eye care but
primary care, period, as we remain
vigilant for those at risk. ■