Diabetes is no island.
Doctors of optometry have long known that diabetes patients are at greater risk for such comorbidities as hypertension, obesity and dyslipidemia—plus diabetic retinopathy and glaucoma. Recent research underscores diabetes' link to meibomian gland dysfunction (MGD).
MGD, considered the leading cause of dry eye disease, is "a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion," according to the 2011 International Workshop on Meibomian Gland Dysfunction.
Researchers based in Colombia and Spain recently presented their findings via poster at the Association for Research in Vision and Ophthalmology meeting. In their study, they looked at the cases of 73 participants, including 37 with type 2 diabetes, with the remainder in a control group. Beyond the glands, which are located in the tarsal plate of the upper and lower eyelids, the researchers looked at participants' ocular surface and tear function. Participants also responded to two questionnaires.
The findings revealed that 71% of all study participants had MGD; 76% of the participants with diabetes had MGD; 67% of the control group had MGD. Symptoms of MGD were more severe in participants with diabetes.
Looking for MGD in diabetes patients
The study is consistent with similar studies, says Mile Brujic, O.D., who practices in Ohio and closely follows developments related to dry eye and MGD.
"It has been known that the prevalence of dry eye is greater in patients with diabetes," Dr. Brujic says. "MGD is one of the leading reasons for dry eye. This seems to correlate well with what we see in clinical practice."
Still, the study reinforces that doctors of optometry should be on the lookout for the link when patients present. In 2016, they diagnosed more than 320,000 cases of diabetic retinopathy in patients who did not know they had diabetes. Many people learn of their diabetes risks through a dilated, comprehensive eye examination from their doctor of optometry. And the sooner doctors of optometry can detect the biomarkers, the sooner they can educate their patients about managing their disease through diet, exercise and medication.
"With the diabetic patient, often times our primary concern is assessment of the retina for the presence of diabetic retinopathy," Dr. Brujic says. "We need to pay particular attention to the ocular surface and make appropriate recommendations to optimize ocular surface health when signs of MGD exist."
Low Vision Awareness Month is a perfect opportunity to consider implementing such services in your practice and to ensure you have the right connections for necessary referrals to other doctors of optometry who provide this essential care.
Researchers found only about 30% of patients with diabetes abide by four diabetes care practices—including eye exams.