Optometry seeking expanded role in diabetes care

National Diabetes Alert Day on March 26 presented an opportunity for doctors of optometry to inform patients about their growing role in diabetes care.

According to the 2017 National Diabetes Statistics Report from the Centers for Disease Control and Prevention (CDC):

• Diabetes affects 30.3 million Americans (9.4% of the U.S. population).
• About 23.1 million people were diagnosed with diabetes.
• Another 7.2 million people had undiagnosed diabetes.

Diabetes is an issue worldwide, says David Masihdas, O.D., co-chair of the AOA's Evidence-Based Optometry (EBO) Committee guideline development group on diabetes.

"About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major predisposing factors," Dr. Masihdas says. "Today, more than 1.7 billion adults worldwide are overweight, and 312 million of them are obese. In addition, at least 155 million children worldwide are overweight or obese. A diabetes epidemic is underway."

Expanding role of optometry

The AOA has long recognized that optometry has a role in the care of patients with diabetes. However, it's moving more aggressively to demonstrate that optometry can make an even greater impact on diabetes care—by elevating and expanding optometry from a model of detection and routine eye care to timely, critical interventions and management that help reinforce the patients' diabetes care team.

That mindset, which includes point-of-care testing, would require regulatory changes in some states.

"The role of diabetes care for doctors of optometry has not shifted much within the last three decades," says Michael Dueñas, O.D., AOA chief public health officer. "While the dilated eye exam has been our core diabetes responsibility, a tripled prevalence of diabetes over this same time period, and greater overall morbidity and mortality from the disease, means that doctors of optometry must more fully engage in the extended challenge of diabetes in the U.S.

"Doctors of optometry should seek enhanced multidisciplinary practice opportunities (i.e., associating with health centers and rural hospitals) and work to advance their scope of practice to more fully align their primary care role with their medical training and high levels of patient accessibility," Dr.  Dueñas says.

Updating the AOA's clinical guideline on diabetes

Further, the AOA's EBO Committee expects to release in 2019 the update of its landmark 2014 clinical guideline on diabetes.

"The evidence-based clinical practice guideline, Eye Care of the Patient with Diabetes Mellitus, is being updated with the most current evidenced-based information for the optometrist to refer to in clinical practice," says Diane Adamczyk, O.D., chair of the EBO Committee. This updated guideline will be an important resource to assist optometrists in the care these patients."

Several factors are driving the expanded role for doctors of optometry, Drs. Adamczyk and Masihdas say.

"Because of the ocular manifestations of diabetes, the role of the optometrist is significant, but also the optometrist may be the first health care provider to recognize undiagnosed diabetes in a patient," Dr. Adamczyk says.

Adds Dr. Masihdas, who has dedicated a major portion of his practice for the past 20 years to diabetes care: "There is currently a shortage of primary care physicians and this presents an opportunity for optometrists to help patients with diabetes. Certainly, we provide eye care services, but we also need to help patients with their medications, exercise and diet concerns."

AOA offers resources

AOA members can take advantage of these tools and resources in the fight against diabetes:

• See the Eye Care of the Patient with Diabetes Mellitus  clinical practice guideline.
• Find several practice resources here, including some members-only tools.
• Attend continuing education at  Optometry's Meeting^® 2019, June 19-23 in St. Louis. Among the diabetes-related courses being offered:

• OCT Evaluation of the Retina and Optic Nerve, 2 p.m., Wednesday, June 19.
• Retinal Findings with Systemic Disease, 9 a.m., Thursday, June 20.
• In-Office Electrodiagnostics for the Non-Glaucoma Patient, Diabetes, Diabetic Retinopathy, and AMD, 9 a.m., Thursday, June 20.
• 20/30 with Complaint of Near Blur: Vision Rehabilitation and When/How to Refer for Primary Eye Care Provider, 8 p.m., Thursday, June 20.
• Anti-VEGF and the Eye, 10 a.m., Friday, June 21.
• Diabetes 101 for the Primary Care Optometrist, 8 a.m., Sunday, June 23.
• How Systemic Conditions Can Affect the Eye, 8 a.m., Sunday, June 23.

• Read more about optometry's evolving rolein diabetes care in the AOA Focus feature, "21st Century Optometric Care for the 21st Century Pandemic."
  
• Access resources at AOA Marketplace, including the updated Diabetic Retinopathy Fact Sheet.