Eyeworld

69 EW RETINA June 2017 Dr. Wang and colleagues rec- ommend in their second study that point-of-care ophthalmologic ser- vices, particularly those that involve non-mydriatic fundus photography, could help improve adherence to ophthalmic screening guidelines as they have improved screening rates in adults with diabetes. One screening technology suggested by Dr. Szirth is OCT angi- ography. "Through OCTA, eyecare professionals can pick up changes in the eye earlier and help make a diagnosis earlier," he said. "In regard to screening for type 1 diabetes, it is important to note that many people don't like to have their eyes dilated. Canon produced the first non-mydriatic retinal camera 40 years ago to help avoid the discom- fort caused by dilation and screen the eye more easily." Telemedicine has its role in screening for DR, but Dr. Goldfarb encourages regular visits to the oph- thalmologist. "It's not a substitute for a complete eye exam," he said. Education plays an important role in preventing, detecting, and treating DR, and Dr. Szirth thinks getting various medical subspecial- ties to work together is important, including endocrinologists, general practitioners, and eyecare profes- sionals. EW References 1. Wang SY, et al. Ophthalmic screening pat- terns among youths with diabetes enrolled in a large US managed care network. JAMA Oph- thalmol. 2017 Mar 23. Epub ahead of print. 2. Wang SY, et al. Incidence and risk factors for developing diabetic retinopathy among youths with type 1 or type 2 diabetes throughout the United States. Ophthalmology. 2017;124:424–30. 3. Sloan FA, et al. Adherence to guidelines and its effects on hospitalizations with compli- cations of type 2 diabetes. Rev Diabet Study. 2004;1:29–38. Editors' note: Dr. Szirth has financial interests with Canon U.S.A. (Melville, New York). Drs. Goldfarb and Sturdy have no financial interests related to their comments. Contact information Goldfarb: ms_goldfarb@yahoo.com Sturdy: sylvia.pankiewicz@iconeyecare.com Szirth: KZangrillo@golin.com guidelines of obtaining ophthalmic examinations among youths," the investigators wrote. Identifying barriers, implications The length of time between diabetes diagnosis and recommendations for initial screening—or the comple- tion of the actual screening by most patients—surprised Mark Goldfarb, MD, Advanced Eyecare, River Edge, New Jersey. "Waiting years to be screened is inadvisable," he said. "There are likely several issues contributing to [the results], in- cluding the ability to get to exams, health insurance coverage, and maybe most importantly a lack of understanding of the importance of such exams and why individuals need to be screened for them," said Ashley Sturdy, MD, uveitis and reti- nal specialist, ICON Eyecare, Denver. "Awareness and education are key factors." To demonstrate her last point, Dr. Sturdy added that many patients are surprised when she tells them that diabetes can affect the eyes and lead to blindness. "Diabetic retinop- athy can be asymptomatic until later in the disease process, and patients need to understand this in order to schedule regular screenings and stay as ahead of the disease as they can," she said. There's also a fear factor in- volved. "From my experience with patients, I have seen that many fear what the eye screening will show and also fear the possibility of miss- ing time at work for treatment," said Ben Szirth, PhD, director, Applied Vision Research & Ophthalmic Telemedicine, Rutgers University, Newark, New Jersey. Patients may not hear enough information from their PCPs about the importance of eye screenings, considering how pressed PCPs are for time, Dr. Goldfarb observed. Pa- tients, young or old, may already see multiple specialists and consider it a burden to see yet another doctor. Dr. Goldfarb thinks ophthal- mologists should do a better job of encouraging patients to return for regular screenings, perhaps with the use of appointment reminders via email, text, automated calls, or mailed reminder postcards like those commonly used in dentistry. This could encourage patients with diabe- tes to get into the screening habit.

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