If you are having trouble viewing this email, please click the following link.
http://www.visioncareprofessional.com/emails/genentech/newsletter/25/index.html

Successfully Co-Managing Diabetic Patients
Communication between ophthalmologists and endocrinologists/diabetologists is essential.
By Lisa Samalonis, Contributing Editor

Good communication between patients and their co-managing physicians helps ensure diabetic patients receive optimal care. Often, the vision of diabetic patients is excellent and they remain pain-free and asymptomatic. "Nonetheless, they must be tested regularly," says David Boyer, MD, a retinal physician practicing in Los Angeles. "One of the most important questions an endocrinologist can ask diabetic patients is when they last saw an eye doctor for a complete, dilated examination to rule out potential problems," he says.

Advertisement
"Endocrinologists can also request that the ophthalmologist forward a report to their office so the lines of communication remain open between the treating doctors," says Anne Peters, MD, diabetologist, director of USC Clinical Diabetes Programs and Professor at the Keck School of Medicine of USC. Dr. Peters notes she follows up more regularly with patients who require vision treatment for retinopathy. "Having a report from the eye specialist is crucial," she says, because then she knows when the patient needs to return to the ophthalmologist.

Dr. Peters frequently refers to several retina specialists in her area who promptly fax or email each patient's report to her. "Notes from the specialist are kept in each patient's chart, so I can discuss with the patient what the ophthalmologist found," she says.

Monitoring Disease Progression
"Retina specialists should also ask diabetic patients about their condition and the A1C goals they've set with their endocrinologist," says Dr. Peters. "My patients know they're supposed to get their A1C to less than seven, but sometimes that isn't possible because of severe hypoglycemia," she explains. The ophthalmologist can encourage patients to achieve as normal a hemoglobin A1C level as possible and continue working with the endocrinologist.

Other questions ophthalmologists can ask diabetic patients include: how often are they checking their glucose levels; when was the last time they saw their endocrinologist or primary care physician; are they taking their medicines; and have they had their blood pressure checked and, if so, was it in an acceptable range. "The doctors should stay in communication because in many cases, even though the patient has their diabetes under control, he or she is already developing severe diabetic changes," says Dr. Boyer.

Diabetic retinopathy ranges from no visual symptoms to mild blurring of central vision to a complete loss of vision or vitreous hemorrhage. However, some visual changes are normal in diabetic patients. Vision can vary when blood sugar is inconsistent, explains Dr. Boyer. "With those changes, the patient may have to be reassured that the reason they're having major fluctuations is because they're not under control – even though they believe they are," he says. These patients have to take their blood sugar readings more frequently to determine when the increases are occurring.

Follow-up
"With type 2 diabetes, the patient should be examined at the time of diagnosis to make sure no problems are present," explains Dr. Boyer. Adults and children 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years of the onset of diabetes. Patients are then scheduled to see their eye doctor yearly if no problems are detected. "Patients return more often if their A1C hemoglobin isn't under control," he says.

Dr. Boyer emphasizes the importance of a comprehensive dilated eye exam by an ophthalmologist. "Taking one photograph of the back of eye is a good screening technique, but it doesn't rule out the fact that the patient could have proliferative diabetic retinopathy, glaucoma (which is increased in diabetic patients), cataractous changes or other visual problems that may require them to see a doctor," he says.

Better Together
The synergy between the endocrinologist and the ophthalmologist is critical. "Each one of us has our role in a patient's treatment. Joining forces is beneficial to our patients. We can decrease their feelings of panic, encourage appropriate behavior and select the best possible treatments for each patient," Dr. Peters concludes.

Retinal Physician | 323 Norristown Road, Suite 200, Ambler, PA 19002 | 215-646-8700
If you prefer not to receive e-mail from Retinal Physician, please use the following link to remove your e-mail address from this list: Unsubscribe
This message was transmitted by PentaVision LLC | 323 Norristown Road, Suite 200, Ambler, PA 19002 | 215-646-8700
View the PentaVision LLC Privacy Policy | Contact Us - Please do not reply to this e-mail message.
Please make sure our e-mail messages don't get marked as spam by adding visioncareprofessionalemail.com to your "approved senders" list.