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.

BLOG: Transforming diabetes care

I had the unique opportunity to be a member of the first class of a joint venture between the American Optometric Association and the Johnson & Johnson Diabetes Institute.

This 1-day program, held as part of the pre-meeting program of Optometry’s Meeting in Boston, was developed to provide optometrists with a broader perspective on the care for a diabetic patient.

According to the American Diabetes Association (ADA), in data studies from 2012, 29.1 million Americans, or 9.3% of the population, has diabetes. Of these, 8.1 million, or 28%, are undiagnosed. Data from the AOA’s evidence-based clinical practice guideline for Eye Care of the Patients With Diabetes Mellitus finds that diabetic retinopathy is the leading cause of new cases of blindness and low vision in Americans from ages 20 to 74 years. The ADA numbers also show that the rate of increase of diabetes from 2010 to 2012 was 13%. Clearly, diabetes is growing public health issue in America and one the directly affects the eye and vision.

If America wants to get a better handle on this disease, more health care resources need to be applied to the equation. This is where America’s 40,000 optometrists can step up to meet this growing need. To do this, however, optometrists need to do much more than routine eye examinations on patients with diabetes. Unfortunately, most health plans only want one piece of data from the eye exam: retinopathy, yes or no? By the time that answer is “yes,” the patient has moved down the road to end organ damage.

In the Transforming Diabetes Care program at Optometry’s Meeting, we learned a great deal about the problems and challenges of a patient with diabetes. We found that we must treat the patient rather than treat the numbers. The effective treatment involves much more than just a physician prescribing medications. The entire team of health care providers involved in a patient’s care must understand each patient’s social, economic and family issues to develop a long-term treatment plan to prevent end organ damage.

Interestingly, managing diabetes is a lot like prescribing glasses; unless you understand the patient’s individual vision needs, you cannot effectively manage their refractive error. Optometrists need to be an integral part of the management team for any patient with diabetes. We often know our patients better, see them more often and can provide education and counseling that can be a very effective adjunct to overall management success.

For you as an optometrist to provide quality health care to a patient with diabetes, you will need to know the numbers. You need a recent HA1c and you need to know the results of daily blood sugar testing. You need to have your office certified by the CMS Clinical Laboratory Improvement Amendment (CLIA) program. This will allow you to provide an in-office finger stick blood test with a glucometry reading. You will need to work with your patient to self-test each day to learn if their diet and medical treatment plan is effective. It is only when the overall treatment plan is effective in the daily management of blood sugar that you will be able to limit the development of diabetic retinopathy.

To examine a patient with diabetes, skip a blood sugar reading, find that there is no retinopathy and assure them their diabetes is well managed is exactly like doing an examination of a patient with glaucoma, skipping an IOP measurement, looking at the nerve and assuring them that their glaucoma is well managed.

It is clear to me now why this course was titled Transforming Diabetes Care. Providing effective care for a patient with diabetes goes well beyond the current level of care being provided in America. The effective management requires a team approach that includes communication and collaboration among optometrists, physicians, podiatrists, dentists, mental health providers, diabetic educators, dietitians and all health care providers who are managing each patient. We are a critical part of this team; however, we need to move beyond the traditional but limited role of just providing eye examinations for patients with diabetes.

Look for this innovative program from Johnson & Johnson Diabetes Institute and get involved. Perhaps you, too, will become transformed.

Reference:

American Optometric Association. Eye Care of the Patient With Diabetes Mellitus. http://aoa.uberflip.com/i/374890-evidence-based-clinical-practice-guideline-diabetes-mellitus. Feb. 7, 2014.

Johnson & Johnson Diabetes Institute. https://www.jjdi.com/.