Issue link: https://optometricmanagementsupplements.epubxp.com/i/531600
JOSEPH J. PIZZIMENTI, OD, FAAO: The statistics are sobering. More than 29 million people in the United States have diabetes, 1 and if current trends continue, as many as one in three Americans will have diabetes by 2050. 2 During the 2005-2008 timeframe, almost 30% of Americans with diabetes 40-years of age or older had diabetic retinopathy. 3 In fact, diabetes is the number one cause of new cases of blindness among adults in the United States. 1 With its potential to cause microvascular, macro- vascular and neuropathic complications, diabetes requires constant monitoring and management, often involving various medical disciplines. This article highlights several key topics to maximize the effectiveness of these collaborations. Topics include referral patterns, strategies for improving patient adherence and an overview of treatment options for diabetic eye disease . REFERRALS: A TWO-WAY STREET DR. PIZZIMENTI: Dr. Goldberg, when should patients with diabetes have an initial eye examination? RONALD B. GOLDBERG, MD: The American Dia- betes Association recommends an initial dilated, comprehensive eye examination within 5 years of a diagnosis of type 1 diabetes and as soon as possible after a diagnosis of type 2 diabetes. 4 The rationale is that we often don't know when the disease began in someone with type 2 diabetes. Some researchers estimate the time between onset and initial diag- nosis may be 5 to 10 years. 5,6 The time of onset of type 1 diabetes is usually known, and the likelihood of a young person developing retinopathy in the frst 5 years is very low. 4 An alarming trend and potential confounding factor in diabetes management is the increasing prevalence of type 2 diabetes among children and adolescents. One recent study reported a 35% increase in prevalence among youth aged 10 to 19 years during the period between 2001 and 2009. 7 DR. PIZZIMENTI: Dr. Dunbar, how do you manage patients who have diabetes without diabetic eye disease? MARK T. DUNBAR, OD, FAAO: I encourage any patient who has diabetes, whether or not he has retinopathy, to have a comprehensive eye examina- tion once a year, as recommended by the American Optometric Association. If I detect signs of diabetic eye disease, I refer the patient to a retina specialist. DR. PIZZIMENTI: Dr. Albini, to whom do you refer patients for diabetes care? Integrated Cross-disciplinary Approaches to the Management of Diabetic Eye Diseases The complex nature of diabetes requires a strong collaboration between patients and all members of their healthcare teams. JUNE 2015 • 3