Read more from Practicing Medical Optometry:

• Diagnose Diabetic Eye Disease
• Treat Diabetic Eye Disease
• Dive Into Diabetic Eye Care
• BONUS: Zoom Out on Diabetes

As the COVID-19 pandemic has wreaked havoc, causing fear, illness, a financial crisis and loss of life, the significantly higher incidence of serious complications and death among diabetic patients has served as a stark reminder of the long-standing diabetes pandemic itself¹ (see a “History of Diabetes” at end of this article). Here, we’ll discuss the statistics of diabetes and, specifically, how we as doctors of optometry can “flatten the curve” of diabetes.

THE STATISTICS

Today’s diabetes statistics are well known, but still astounding:

• Diabetes is the seventh leading cause of death in the United States (although it’s likely significantly higher, due to its impact on other conditions, such as cardiovascular disease).²
• More than 34 million Americans have diabetes (~11% of the population), with 1 in 5 unaware of their diagnosis.²
• More than 88 million Americans have prediabetes, with >84% of them not knowing it.²
• There were about 1.5 million new cases of diabetes in 2018 in U.S. adults age 18 or older.³
• It is predicted that 1 in 3 adults will have diabetes by 2050.⁴
• Diabetes is the leading cause of vision impairment worldwide in the 20 to 74 age group.⁴
• Diabetes is the fifth leading cause of blindness worldwide.⁵
• An estimated 20% to 40% of patients with Type 2 diabetes already have retinopathy at their initial diabetes diagnosis.^6,7

While we appropriately focus on diabetic retinopathy (DR) because of its potentially sight-threatening complications, diabetes also is associated with increased incidence of papillopathy, glaucoma (all forms), ocular surface disease (including dry eye disease), cataracts and keratopathy.

These mind-boggling statistics underscore the vital role doctors of optometry play in the care of diabetic patients, both in the anterior and posterior segment of the eye, and their overall systemic health.

HOW TO MAKE A DIFFERENCE

It all starts with education and communication. We can:

• Keep our eyes open. Just this year, the FDA approved a second standalone, artificial intelligence (AI)-based screening system to automatically analyze retinal photographs for signs of diabetes, without a doctor of any kind being involved. While AI-based systems can be a useful adjunct to doctor-driven exams, we must be proactive in identifying the pathology of diabetic eye disease in our offices, corresponding with other members of the patient’s health care team, such as their primary care provider, and reporting our findings to the patient’s insurer.
• Provide patient education. As Timothy Petito, O.D., has pointed out in his work on behalf of the profession through various volunteer roles with the American Optometric Association, it’s not simply a finding of retinopathy that yields better overall diabetic health outcomes, it’s the conversations we have with those patients that drive home the message and produce positive change. AI-based retinopathy screening platforms, which don’t involve patient-doctor interaction, can’t effectively replicate that, especially since we are often the entry point to the health care system as patients seek relief from presbyopia, and then later develop age-related eye diseases, such as glaucoma and cataracts. In summary, we have a unique opportunity to emphasize to patients the importance of managing their diabetes and other systemic diseases.
  Explaining and allowing patients to view the images of their eyes captured in the office (e.g. photos and/or OCT scans when retinopathy is present) can be an extremely powerful driver of compliance, especially when also reminding patients their retinal health is a good indicator of how other organ systems are likely faring with their disease. These simple, brief discussions can have a lasting and significant impact, fostering adherence to both prescribed treatments and follow-up appointments.
• Encourage blood sugar control. Taking a few extra seconds to encourage patients reduces their chances of diabetes-related vision loss:
  “Mr. Smith, watching what you eat, taking your medications, exercising moderately and keeping your doctors’ appointments are critical to helping control your blood sugar, which significantly reduces your chances of vision loss, as well as other complications from diabetes.”

PROVIDE A GUIDE

Diabetic patients across the country are benefitting from doctors of optometry who actively seek and manage diabetes, creating patient loyalty and receiving referrals from friends, family and other health professionals with whom they collaborate on care. For more advice and guidance on caring for these patients, Dr. Zach McCarty provides an overview of the latest diagnostic tools and strategies aiding in the detection of diabetic eye disease in “Diagnose Diabetic Eye Disease,” p.20; Drs. Mohammad Rafieetary and Jessica Haynes discuss new and emerging diabetic eye disease treatments in “Treat Diabetic Eye Disease,” p.26; and Dr. Peter Cass explains the practice management implications and opportunities that caring for diabetic patients affords in “Dive Into Diabetic Eye Care,” p.30.

As primary eye care physicians, it is incumbent upon all of us to stay abreast of this pandemic disease. There is likely no greater opportunity within our profession to have such a profound impact on patient morbidity and mortality than with diabetes, so let’s seize the opportunity and make a difference! OM

REFERENCES

1. Worried about the Coronavirus? Here’s what you should know. American Diabetes Association Website. https://www.diabetes.org/covid-19-faq . Accessed September 9, 2020.
2. Diabetes Fast Facts. Centers for Disease Control and Prevention Website. https://www.cdc.gov/diabetes/basics/quick-facts.html . Accessed September 9, 2020.
3. U.S. Department of Health and Human Services – Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.Pdf . Accessed September 9, 2020.
4. CDC Newsroom: Press Release. Number of Americans With Diabetes Projected to Double or Triple by 2050. The Centers for Disease Control Website. https://www.cdc.gov/media/pressrel/2010/r101022.html . Accessed September 9, 2020.
5. The Importance of Treatment With Good Glucose Control Cannot Be Underestimated. People With Diabetes Can Prevent Vision Loss. The National Eye Institute Website. https://www.nei.nih.gov/sites/default/files/2019-06/diabetes-prevent-vision-loss.pdf Accessed September 9, 2020.
6. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM Occurs at Least 4-7 yr Before Clinical Diagnosis. Diabetes Care 1992; 15(7):815-19.
7. Kohner EM, Aldington SJ, Stratton IM, et al. United Kingdom Prospective Diabetes Study, 30: Diabetic Retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. Arch Ophthalmol 1998; 116(3):297-303.

DR. WROTEN is a partner at the Bond-Wroten Eye Clinics, a three-location private practice in southeast Louisiana. He specializes in hard-to-fit contact lenses and has spoken for and been an advisory board member with Alcon this past year.