Patients with diabetes often see their retina specialists more often than they do their primary care doctors or endocrinologists, which gives retina specialists a unique role in caring for people with ophthalmic complications of diabetes. Large studies have shown that the risk of developing diabetic retinopathy and its progression is associated with elevated hemoglobin A1C (a marker of diabetes control over the preceding three months), blood pressure and cholesterol level. Yet ophthalmologists are often unaware of how well their patients are controlling these risk factors.
With guidance from Michigan Medicine endocrinologist Jennifer Wyckoff, M.D., Kellogg ophthalmologist Anjali Shah, M.D., a retinal specialist, has developed a plan to introduce more preventive aspects into diabetes eye care. Technicians receive training on how to determine the duration of the diagnosis of diabetes, hemoglobin A1C levels, blood pressure and a known diagnosis of kidney disease. A hemoglobin A1C level greater than nine, diabetes duration greater than 10 years, presence of kidney disease or blood pressure higher than 140/90 places patients in a high-risk group. Those who have two or more of these risk factors are offered education and counseling about resources available from the state, county and U-M.
Three technicians have been trained to perform this additional counseling: Londa Reid-Sanders, Moella Hesselgrave and Madison Boss. They make patients aware of treatment goals, discuss resources available to them and inquire about barriers to care. Patients are given a test prior to this counseling
to determine their level of diabetes knowledge.
Operating for one year and already helping more than 2,000 patients, the program is evolving as lessons are learned about how to better care for patients within a busy retina clinic. For example, the team has found that patients mention that depression and anxiety often interfere with self-care.
A critical goal of the program is to help predict which patients will develop complicated retinopathy and those who will need many or only a few treatments. Dr. Shah and her team are using the electronic medical record system to build a registry with longitudinal data.
“We are committed to understanding diabetic retinopathy as a manifestation of a larger, systemic metabolic disease,” she says.