Optometrists ID Huge Number of Patients With Undiagnosed Diabetes

Pam Harrison

December 05, 2016

Doctors of optometry (OD) in the US picked up almost one-quarter of a million patients in 2014 alone who were found to have diabetes-related manifestations, which eventually led to a diagnosis of diabetes, but who had been unaware they had it and were thus not being treated, according to new research from the American Optometric Association (AOA).

The survey was released to coincide with American Diabetes Month in November.

"Yes, it is an amazing number, but people don't realize that doctors of optometry provide the majority of eye care in the US," AOA president Andrea Thau, OD, told Medscape Medical News in an interview.

"We are in 6500 communities across the country, and as part of our comprehensive eye examination, we take detailed medical histories, we check blood pressure, we ask when patients were last seen by a physician and about their current health conditions as well as what medications they are on, because all of these things have an impact on eye and overall health," she explained.

"And for many patients, we are sometimes the only medical provider…being seen, and the number of people we found with previously undiagnosed diabetes gives you an idea of the magnitude of people who are not going for regular medical care," she stressed.

Seeing Into the Body Without Being Invasive

And Dr Thau pointed out, the eye is the only part of the body where practitioners can visualize blood vessels without cutting into the body.

"What we are looking for are dilations of the vessels and small hemorrhages and leakages as early signs of change in the back of the eye," she explained.

Doctors of optometry can also identify shifts or changes in a patient's refractive error when diabetes is not well controlled, she added.

"Once we find diabetes, we educate patients about the importance of getting a comprehensive physical checkup with their physician," Dr Thau said.

The next step is to send a letter to the primary-care physician or try to contact them and attempt to follow patients up to make sure they are being seen by a physician.

Depending on the patient's age and how well controlled their diabetes is, patients are encouraged to return for a comprehensive eye exam twice a year to ensure their eye health remains as well preserved as possible.

"We often take care of patients from the cradle to the grave, so there is a level of trust that people have with their doctor of optometry, and I think they know we really do care about them and we want them to get better and stay well," she observed.

"So we are really an integral part of the diabetes care team and on follow-up, we can assess whether patients are being compliant with their medications, what their HbA1c levels are, how their eyes look, and whether they need to speak with their primary-care physician and ask for a referral to a nutritionist, for example, so they can be counseled on how to take better care of themselves.

The AOA advocates for regular, dilated eye exams for those with diabetes or at risk for diabetes, because the alternatives, like online vision apps, check only for refractive errors like nearsightedness, farsightedness, or astigmatism and cannot detect diabetes.

"When the eyes are dilated, an eye doctor can examine the retina for signs of diabetic eye disease and prescribe a course of treatment to help preserve an individual's sight," Dr Thau said. "Many eye problems show no symptoms until they are in an advanced stage, but early detection and treatment can truly save a person's vision. No online app can do that."

"You only get one pair of eyeballs, so it's really important for patients to understand the value of getting a comprehensive eye exam with a doctor of optometry on an annual basis because we can monitor and detect changes very early on and protect and preserve a patient's vision and their overall health," Dr Thau stressed.

Annual Eye Exams Reveal Diabetes, Diabetic Retinopathy, and More

The AOA has also just conducted a new American Eye-Q Survey, released last month to coincide with World Diabetes Month. This indicates that only 54% of patients with diabetes regularly visit their doctor of optometry for a comprehensive annual eye exam.

And fewer than half of those surveyed, at 41%, understand that diabetes can be detected through a comprehensive eye exam.

The survey also showed that doctors of optometry diagnosed diabetic retinopathy in 14% of patients with diabetes. Diabetes is the leading cause of blindness in individuals under the age of 74.

In addition to picking up a systemic problem such as diabetes, "we can also see signs of hypertension and other blood vessel diseases," Dr Thau noted.

The eye is an extension of the brain, so doctors of optometry are in an ideal position to detect neurological problems as well — brain tumors, multiple sclerosis, aneurysms, all of which Dr Thau says she has identified during her career as a doctor of optometry.

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