Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

Metabolic syndrome a critical diagnosis for the primary care optometrist

If one were to consider which diseases would be significant for the practice of optometry, one would have to think of glaucoma. After all, we spend many hours of continuing education on this topic. Many states require specific education about this disorder. Optometrists spend a large percentage of their capital expenditure budget on instruments to diagnose and manage this problem. However, the prevalence of glaucoma in the U.S. is only about 2%

A much more common disorder that optometrists see and one for which they can have a larger role in its management is that of metabolic syndrome. This serious medical problem has a U.S. prevalence of 25%, and the key management is lifestyle changes that can be recommended during a comprehensive medical eye examination.

Metabolic syndrome is a group of risk factors that increase the risk of heart disease, stroke, diabetes and a number of other health problems. There are five metabolic conditions, and the presence of any three of them makes up the diagnosis of metabolic syndrome. According to the National Heart, Lung and Blood Institute, the five risk factors are:

  • A large waistline (greater than 40 inches for men or 35 inches for women). This also is called abdominal obesity or having an “apple” shape.
  • A high triglyceride level (150 mg/dL or being on medicine to treat high triglycerides).
  • A low HDL cholesterol level (40 mg/dL or being on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol.
  • High blood pressure (135/85 mm Hg or being on medicine to treat high blood pressure).
  • High fasting blood sugar (100 mg/dL or being on medicine to treat high blood sugar).

Optometrists commonly see patients that easily meet these criteria or are relatively young and on track to have this diagnosis before their 40th birthday.

The best treatment of this disorder is to educate patients about the above the risk factors and advise exercise, a healthy diet and the frequent monitoring of these factors. Although genetics plays a role in the development of this problem, behavior modification can affect the outcome and be a more successful management plan than with many other chronic health problems.

As optometrists join the primary care team in addressing the nation’s health, this disorder is a great place to start the transition to primary care. The problem is easily diagnosed as part of a comprehensive eye examination. Many patients over the age of 40 are on fish oil for triglycerides and a statin for cholesterol. This gives them two risk factors by history. If they are on a medicine for sugar control, the diagnosis is made. From there, it is easy to see if the waist size is inappropriate, calculate the body mass index or measure a blood pressure above the limit. Many patients will already have three problems under treatment but will have never heard of this syndrome and not be aware that they are at risk.

Perhaps more important than the discussion with patients who have the diagnosis is the education about this syndrome for younger patients with a strong family history who are gaining weight at each eye exam. One of the major contributions of optometry to improving the nation’s health is the primary heath care of young people who see us every year for refractive error management. Patients in their second and third decade often list the optometrist as their only health care provider, and these are the very years where diet and exercise habits are developed. Personal health education and counseling in these years can allow patients to set realistic goals and avoid each of the risk factors of this syndrome.

As health care reform measures such as the Affordable Care Act reveal how complex and complicated it can be to attempt to improve America’s health, the management of metabolic syndrome by optometrists is a simple step that can provide a great benefit.