o.d. to o.d.

Retina: Your Role in Managing the New Frontier

Challenge yourself to take a fresh and more comprehensive approach to managing and preventing retinal disease.

BY SCOT MORRIS, O.D., F.A.A.O.

As the baby boomer generation reaches 65, the world faces an epidemic of degenerative retinal disease. Also, the rate of diabetes in our youth and young adults is skyrocketing. The new frontier for medical eye care is the retina, and we are uniquely positioned to assist in the management and treatment of this epidemic.

Now, I completely understand that optometry is not injecting bevacizumab (Avastin, Genentech) or performing invasive retinopexy, but that does not eliminate our need to be ever-observant of changes in our patients’ retinas. Nor does it eliminate our duty to provide prophylactic therapies and proactive patient education. Maybe retinal disease was diagnosed and referred out for treatment in the past. However, I want to challenge you to take a new and more comprehensive look at retinal disease.

A new look at retina disease

This new look includes four actions: (1) comprehensive patient education, (2) preventative therapies, (3) aggressive monitoring in high risk patients and (4) proactive interdisciplinary referrals. Aggressive monitoring may mean more frequent, detailed examination of at-risk patients. For example, patients who have uncontrolled diabetes need frequent diagnostic testing so we can detect any visual or physical changes. They may also require interdisciplinary referrals to an endocrinologist and/or a nutritionist — an often overlooked but crucial part of care. Patients who have genetic risk for AMD or pre-existing drusen may require frequent monitoring, extensive patient education about the potential complications of AMD and an early referral.

The best therapy?

Preventative therapies are often the best treatments. Eyewear recommendations and nutritional education are essential to the prevention of AMD. Prevention starts in childhood with lens materials that block UV, such as polycarbonate. This means every patient should receive back-surface AR to prevent the harmful UV reflected directly into the eye from posterior reflections. It also means education and an aggressive approach to sunwear utilization for each and every patient — especially children. Active involvement also includes the sometimes uncomfortable tasks of discussing lifestyle modifications, like smoking cessation or weight management. Our goal is to prevent vision loss before it begins, not to treat it once it occurs. This may even mean educating patients about nutritional supplements and even selling them in your office to increase patient compliance and convenience. All these things are our job.

Passing the baton to you

Gone are the days when retinal patient care and management is the sole responsibility of retina specialists — the baton is being passed to optometry. Please read on, and identify two to three new ways you can take a more interactive role to prevent retinal disease. After all, patients cannot determine their risk. For this, they rely on you. OM