Everyone with diabetes—including patients with both type 1 and type 2, and independent of the severity of their disease and/or the adequacy of its control—should undergo annual dilated eye examinations at a minimum. Those with significant diabetic retinopathy and poor diabetic control may need to be seen on a more frequent basis and additional testing—including fluorescein angiography (FA) and optical coherence tomography (OCT)—performed if clinically warranted, particularly if diabetic macular edema (DME) or neovascularization and proliferative changes develop. Various stages of diabetic retinopathy and DME can be diagnosed on dilated retinal examination and confirmed with special diagnostic testing, including fluorescein angiography and optical coherence tomography.
Partnering With Other Specialists
Although it is expected that the Healthy Sight Counselor will, by inclination and by training, concentrate on the ocular complications of diabetes, it is important to keep in mind that diabetic retinopathy is one of many manifestations of a complex and serious systemic disease that can threaten life as well as vision. A strong working partnership and open network of communication between the vision care professional and the internist, pediatrician, or endocrinologist treating the diabetic is crucial to promote both Healthy Sight and Healthy Life.
In addition to taking an ocular history, the vision care professional practicing
Healthy Sight Counseling should also take a medical history, routinely inquiring about the status
of the patient’s diabetes—specifically about hemoglobin A1C levels and pre-
and post-prandial blood sugars. Glycemic control is the hallmark of effective
therapy of diabetes, and hemoglobin A1C is an important indicator of the
state of glycemic control. The optimal A1C is 6.5-7.0%. It has been estimated
that for every 1% decrease in elevated A1C the likelihood of developing DR
decreases by 21% and the likelihood of its progression decreases by 43%.
Healthy Sight Counseling for the diabetic should include patient reminders about recommended follow-up for diabetes the eye disease, as well as for diabetes the systemic disease. And, as in all aspects of Healthy Sight Counseling, patient education is important, because if patients understand their disease and are made aware of the potential consequences of not treating it properly, they are more likely to be compliant with recommended guidelines.
This educational aspect of Healthy Sight Counseling needs to go one step further, however, with diabetes. Vision care professionals practicing Healthy Sight Counseling should also educate those medical professionals partnering with them in the care of diabetic patients on important aspects of diabetic eye disease, bringing them up-to-date on the latest therapies available to address the serious vision-threatening ocular sequelae of diabetes.