November is National Diabetes Month
November is National Diabetes Month and a time to raise awareness about diabetes and diabetic eye disease, a group of eye conditions that can result from diabetes.
Paula Anne Newman Casey, M.D., MS, associate professor of ophthalmology at the University of Michigan and principal investigator of the MI-SIGHT study funded by the Vision Health Initiative at the Centers for Disease Control and Prevention, discusses the measures that eye health professionals can use to provide effective care for people with diabetic eye disease.
Paula Anne Newman-Casey, MD, MS
Education Director, Kellogg Eye Center for eHealth
Assistant Professor, Department of Ophthalmology & Visual Sciences
University of Michigan
Q. How does diabetes affect a person’s eyes?
A. Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. Diabetic retinopathy, for example, is one such eye condition that can cause vision loss and blindness in people who have diabetes. It is the leading cause of blindness in working-age U.S. adults. This eye condition affects blood vessels in the retina, or the light-sensitive layer of tissue in the back of your eye. The retina is a key part of your vision, as it acts like the film in the camera that captures the image to send to the brain so that you can see. When the blood vessels in the retina are affected by sugar levels being too high in the blood, they begin to leak and bleed. These problems often begin on a small scale, where they do not affect the center of the retina that affects our most precise vision. But, left untreated, the leaking and bleeding of blood vessels can lead to vision loss.
Q. What can people do to prevent vision loss and blindness caused by diabetes?
A. It is important for people to manage their diabetes. By controlling blood sugar, blood pressure and cholesterol, people can reduce the risk of developing eye disease that affects the retina. Early diagnosis and treatment of diabetic retinopathy – the bleeding and leaking blood vessels – can prevent vision loss and blindness. Regular dilated eye exams by an eye care professional such as an optometrist or ophthalmologist are important because these eye care professionals can detect and treat retinal eye disease. The problem is that often people are not screened properly for retinal eye disease or receive screening too late for treatment to fully restore vision.
Ensuring that people receive appropriate screening for diabetic eye disease is part of high-quality care for people with diabetes. The National Committee on Quality Assurance (NCQA), which helps health plans work together to improve the quality of care, includes screening or monitoring for diabetic retinal disease as a key marker of quality for comprehensive diabetes care.
Q. How is your MI-SIGHT program reaching those at risk for diabetic eye disease and what are you doing to help prevent their vision loss?
A. The MI-SIGHT program is using a technology-based approach to screen for the leading causes of vision loss. We have ophthalmic paraprofessional staff at a Federally Qualified Health Center (FQHC) clinic and at a free clinic who conduct the eye screening and use cameras to take images of the eye that are remotely read by an ophthalmologist to detect eye diseases that include diabetic retinopathy.
The health care providers at the FQHC call all the patients with diabetes who are overdue for their annual diabetic screening exam and ask if they would be interested in completing an eye screening that looks not only for diabetic retinopathy but also for other leading causes of blindness. After the MI-SIGHT program started, the FQHC improved the percentage of people with diabetes who received an eye exam from 18% to 27%. The program was able to target individuals with diabetes and screen them for all eye diseases that could lead to vision loss and blindness.
The MI-SIGHT technicians in the clinics also assist people in purchasing low-cost eyeglasses that are commercially available through an online retailer, but many people living in lower income areas or living with lower income may not have access to computers or credit cards or be comfortable purchasing glasses online. They also help patients in correctly fitting these eyeglasses. Overall, our program is expanding the reach of eye care by engaging people with diabetes and offering comprehensive eye disease detection and help accessing recommended follow up care through care navigation while helping people obtain low-cost eyeglasses. This holistic approach to eye care has increased patients’ trust in our program. Now, about half of the people who enroll in our eye disease screening program come because of word-of-mouth – a friend of family member recommended it. This metric demonstrates the value of holistic eye disease screening that includes screening for diabetic retinopathy and other causes of vision loss and the provision of affordable, fashionable eyeglasses.