Let’s remember the anterior eye component of diabetes
When nothing seems to be going right, my mother uses a particular phrase to describe the situation. She says, “you’re just snake-bit.” This means there’s nothing you can do to remedy it, and it’s likely to get worse. Often, diabetic patients face an uphill battle with their disease and feel a little “snake-bit.” The good news: We can weaken this venomous disease by monitoring patients for diabetic eye disease and actively questioning them about and treating them for dry eye disease (DED).
MONITORING PATIENTS
I think most, if not all, of us have got this action step down. There’s good reason to monitor the posterior segment carefully, as diabetic retinopathy is the most common cause of visual impairment and blindness in working-age adults.1 In fact, the condition is expected to climb from 7.7 million Americans in 2010 to a staggering 14.6 million in 2050.
Thus, as we enter the exam room to see diabetes patients, we typically prioritize related patient education, the diagnostic evaluation and, ultimately, vision-preserving treatments and recommendations.
ACTIVE DED QUESTIONING/TREATING
Here’s where I think we could use a little work. All too often there can be a disconnect between the “posterior” priority of the doctor and the “anterior” complaint of the patient. Both sides are talking, but no one is really listening. As optometrists, I think we need to do a better job of both asking about and listening for DED issues in our diabetes patients. After all, diabetes has been identified as a risk factor for DED in multiple studies. In fact, one study shows meibomian gland dysfunction is more severe in diabetic patients vs. nondiabetic patients, with a longer duration of the condition linked with significant symptoms and alterations in the meibomian glands.2
While diabetic patients may visit us as a necessity of monitoring their systemic disease, they’re not unlike the other patients we see: They, too, experience anterior segment issues, namely DED. As a result, they too want relief from ocular irritation, blur and burning. Let’s consider connecting with our diabetes patients on their comfort concerns. Doing so may actually make them more receptive to our education and recommendations about their diabetes.
Compliance can be helped or hindered by the patient-physician communication channel. When patients have doctors who listen to them, they tend to listen back. That’s no snake oil! OM
At the time of the publication of this article, Dr. Hauser was an employee of Novartis Pharmaceuticals Corporation.
DIABETES PMO
For additional coverage on diabetes, see the Diabetes PMO at optometricmanagement.com/practicing-medical-optometry.
REFERENCES
- Centers for Disease Control and Prevention. Watch Out for Diabetic Retinopathy. https://www.cdc.gov/features/diabetic-retinopathy/index.html#:~:text=Diabetic%20retinopathy%20is%20one%20of,7.7%20million%20to%2014.6%20million . Accessed Sept. 25, 2020.
- Garzon JSP, Alemany-Lopez A, Sampedro-Gene A. Correlation between type 2 diabetes, dry eye and meibomian glands dysfunction. J Optom. Oct-Dec 2019;12(4):256-262.doi: 10.1016/j.optom.2019.02.003. Epub 2019 May 23.
