Diabetes Retinopathy Clinical Care and Overall Diabetes; Factors that Contributes to Good Performance by IROAGANACHI.V.C., OD, MSc DIA

• On recognition of any ocular signs or symptoms of diabetes, Immediate referrals should be made to patient’s G.P, for relevant blood glucose test. In some instances patients may require to be stabilized before booking an appointment, for example patients with very high blood glucose or those in shock or coma.

• After the diagnoses of diabetic retinopathy or maculopathy, which may include other associated eye diseases or anomalies. Specialized referrals should be made for urgent or routine ocular intervention to salvage patients ocular health.

• Optometrists should be able to make referrals to the patients G.P or ophthalmologist for optimal blood sugar and blood pressure control for at least 8 weeks before surgery will be scheduled by the ophthalmologist. Either for laser, cataract surgery or Intra-vitreal  injections of anti-vascular endothelial growth.
• Former prescribed glasses or vision aid may be left unchanged until prospective ocular interventions are concluded.

•  Post-Operative ocular education and management should be undertaken by the Optometrist with a view to ensure stable or improved visual acuity amid towards 20/20. Adequate healing process of the eyes should be noted.

Introduction of effective call and re-call processes may help improve patients’ attendance for relevant health interventions, such as;

• Fasting plasma glucose check or review.
• Optometrist or Ophthalmologist review and Interventions.
• G.P or Endocrinologist review or interventions.

Some literature review studies have noted that timely uptake of interventions resulted to positive management outcome, and a better quality of life.

It is important to note that opportunistic retinal examinations during normal eye examination has been pivotal to some early diagnosis of diabetes, following identification of diabetic retinopathy and then onward referrals to G.P for further investigation.

I created a process I call the ” cyclic bond for diabetic retinopathy, and various emergency ocular interventions.” I hope optometrist can adapt to the concept.

See diagram below, on how the cyclic bond works to ensure effective diabetic retinopathy clinical care.

• G.P/PN;  General practitioners or practice nurse(OPCD). Ensures DM diagnosis and Referrals.

• OPT/OPH; Optometrist/Ophthalmologist through retinal examination identifies diabetic retinopathy makes referrals.

• G.P/ ENDOCT; General practitioners/ Endocrinologist makes Referrals after DM management to ensure optimal blood glucose level for patients awaiting ocular intervention.

• OPT/OPH; They eye practitioners receives referrals, after endocrinologist interventions for onward ocular interventions. Which may include laser, cataract surgeries or Intravitreal injections, they also refers confirmed diabetic retinopathy cases during opportunistic screening.
• It is interesting to note that hypothetically the  relationship maintained between the cyclic bond medical practitioners illustrated above ensured reduction of blindness or complications of diabetes, from diabetic retinopathy or any associated eye diseases. However studies on the effectiveness of the cyclic bond operations may be appropriate. Regular updates of patients demographic data collected have ensured adequate ocular interventions are made to avert vision loss or adverse complications of diabetes.

Doctors of optometry may have further duties to perform, which includes the use of certain pharmacological agents to manage certain eye complications arising from diabetes complications before referrals to ophthalmologist. Hope you enjoyed my short review on diabetic retinopathy management pathways for optometrist, Please follow, like and comment on my facebook page and website, you can also subscribe for newsletter from my website.

Email me directly if you require references. Thank you.