Optometric Management Supplements

June 2015

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with type 1 diabetes should be in the care of an endocrinologist as should the more diffcult to control patients with type 2 diabetes, because of the complexity of the disease. AIDING ADHERENCE DR. PIZZIMENTI: Patients who have diabe- tes often have diffculty adhering to their therapy, which includes both their treatment plan and changes in lifestyle. Are there strategies that help improve adherence? DR. GOLDBERG: Information and under- standing are prerequisites for adherence. Patients need to know not only how the medicines work and how they should be used, but also the relationship between hyperglycemia and the complications of diabetes. DR. ALBINI: Similarly, I've seen patients from other retina clinics who have under- gone procedures, such as panretinal photo- coagulation, but were not educated about the goal of the treatment. Consequently, they assumed that the procedure would help them see better. Instead, they may have had some vision loss, either from the laser or from persistent macular edema, and as a result, they distrust the physician. Having undergone a painful procedure that didn't produce the outcomes they expected, these patients often don't return until they hemorrhage or experience some other adverse event. We're all get- ting busier in our clinics and trying to be more effcient, but we must remember that explaining treatment goals is crucial. IMAGING TOOLS FOR DIABETIC EYE DISEASE DR. PIZZIMENTI: Until the last few years, an initial diag- nosis of clinically signifcant macular edema was based on examination and observation. How has that changed? DR. ALBINI: Whether or not macular edema is clinically signifcant, as defned by Early Treatment Diabetic Retinopathy Study (ETDRS), 11 is no longer an issue. We now use OCT to determine if the edema is center-involving or noncenter-involving, and we base our treatment decisions on that fnding. DR. PIZZIMENTI: Is OCT the new gold standard for diagnosing and monitoring macular edema? DR. ALBINI: In the retina community, OCT is clearly the standard of care, particularly in patients whose BCVA is worse than 20/20 without another obvious cause of vision loss. In a patient with diabetes, even without retinopathy, we must rule out macular edema, and OCT helps. DR. PIZZIMENTI: Where does fuorescein angiography ft into the retina workup? DR. ALBINI: The number of fuorescein angiograms we perform has decreased signifcantly. OCT is a faster and easier test for patients to undergo, and for many conditions, it's a more defnitive test. That said, however, angiography is still useful to detect focal areas of edema, which often cannot be appreciated on OCT. In addition, fuorescein angiography is better able to detect macular ischemia, which is important in terms of a patient's prog- nosis. We really can't make that kind of assessment using OCT. DR. PIZZIMENTI: Another imaging technology of interest is widefeld angiography, which may be useful for detect- ing areas of capillary nonperfusion in the periphery. DR. ALBINI: Widefeld imaging technologies are helping us learn more about the circulation of the peripheral retina. Being able to recognize large areas of nonperfusion is particularly helpful, because we know those are areas of intense vascular endothelial growth factor (VEGF) produc- tion that may lead to macular edema. JUNE 2015 • 5 Please take the post test and evaluation online by going to OptometricManagementDMECE.com

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