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Optometric Care of the Patient with Diabetes

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Optometric Care of the Patient with Diabetes CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE EST. 1939 VOLUME 79, SUPPLEMENT 2, 2017 CLINICAL RESEARCH 2017 CAO Clinical Practice Guideline: Optometric Care of the Patient with Diabetes Publications Mail Agreement No. 40063055 2 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017 CANADIAN JOURNAL of OPTOMETRY REVUE CANADIENNE D’OPTOMÉTRIE Vol 79, Supplement 2, 2017 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE Winter/Hiver 2017 EST. 1939 VOLUME 79, SUPPLEMENT 2, 2017 ISSN 0045-5075 The Canadian Journal of Optometry is the official publication of the Canadian Association of Optometrists (CAO) / La Revue canadienne CONTENTS d’optométrie est la publication officielle de l’Association canadienne des optométristes (ACO) : 234 Argyle Avenue, Ottawa ON, K2P 1B9. Phone 613 C CLINICAL RESEARCH 235-7924 / 888 263-4676, fax 613 235-2025, e-mail [email protected], website www.opto.ca. Publications Mail Registration No. 558206 / Envoi de publication 5 INTRODUCTION – Enregistrement no 558206. The Canadian Journal of Optometry / La Revue 6 ABBREVIATIONS canadienne d’optométrie (USPS#0009-364) is published four times per year. Address changes should be sent to CAO, 234 Argyle Avenue, Ottawa, 7 CLASSIFICATION, DEFINITIONS, ON K2P 1B9. RISK FACTORS DEFINITION OF DIABETES The CJO*RCO is the official publication of the CAO. However, opinions and commentaries published in 12 DIABETIC RETINAL DISEASE the CJO*RCO are not necessarily either the official opinion or policy of CAO unless specifically identified as such. Because legislation varies from province to 17 NON-RETINAL OCULAR COMPLICATIONS province, CAO advises optometrists to consult with OF DIABETES MELLITUS their provincial licensing authority before following any of the practice management advice offered in CJO*RCO. The CJO*RCO welcomes new advertisers. 19 DIAGNOSIS OF OCULAR COMPLICATIONS CAO reserves the right to accept or reject any OF DIABETES MELLITUS OPTOMETRIC EXAMINATION advertisement submitted for placement in the CJO*RCO. OF A PATIENT WITH DIABETES La CJO*RCO est la publication officielle de l’ACO. 21 MANAGEMENT OF OCULAR COMPLICATIONS Les avis et les commentaires publiés dans la CJO*RCO ne représentent toutefois pas nécessairement la OF DIABETES MELLITUS position ou la politique officielle de l’ACO, à moins qu’il en soit précisé ainsi. Étant donné que les lois 25 CONCLUDING REMARKS sont différentes d’une province à l’autre, l’ACO conseille aux optométristes de vérifier avec l’organisme provincial compétent qui les habilite avant de se con- 26 APPENDIX 1: DIAGNOSTIC CHARACTERISTICS, former aux conseils de la CJO*RCO sur la gestion de leurs RECOMMENDED FOLLOW-UP, AND REFERRAL activités. La CJO*RCO est prête à accueillir de nouveaux annonceurs. L’ACO se réserve le droit d’accepter ou de BY STAGE OF DIABETIC RETINOPATHY refuser toute publicité dont on a demandé l’insertion dans la CJO*RCO. 27 REFERENCES Editor- in - Chief / Éditeur en chef Dr Ralph Chou Academic Editors / Rédacteurs académiques University of Waterloo, Dr B. Ralph Chou, Université de Montréal, Dr Claude Giasson Canadian Association of Optometrists/L’Association canadienne des optométristes Rhona Lahey, Director Marketing and Communications/ Directrice du marketing et des communications Published by: On the Cover An example of severe non-proliferative diabetic retinopathy. Image courtesy maracleinc.com of Prof. Paolo Stanga. CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017 3 4 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017 CLINICAL RESEARCH C 2017 CAO Clinical Practice Guideline: Optometric Care of the Patient with Diabetes Chris Hudson, Introduction BSc (Hons), PhD, MCOptom (UK), PgCUT; The Canadian Association of Optometrists (CAO) is the national voice of University of Waterloo optometry and is dedicated to collaboratively advancing the highest stan- dard of primary eye care through the promotion of optimal vision and eye Dianna Leong, BSc, OD; health, in partnership with all Canadians. Foresight Eyecare Optometrists are the front line of eye health and vision care. They are ex- Erin Loewen, BSc, OD; perts in primary eye care and are well-positioned to help combat the vision- Village Optical related complications of diabetes. Derek MacDonald CAO assembled the Diabetes Guidelines Working Group to create national guidelines on the clinical management of diabetes mellitus in an effort to OD, FAAO; further educate Canadian optometrists and assist them in the management Ilex Eye Associates of this chronic disease. The Working Group consists of optometrists from private practice, research and academia, chosen on the basis of their exper- Angie Machmer, OD; tise, experience and representation from across Canada. Emerald Park Eye Care, THE DIABETES GUIDELINES WORKING GROUP MEMBERS ARE: Ken Mandadakis, BSc, OD; Chris Hudson, BSc (Hons), PhD, MCOptom (UK), PgCUT; Dr. Ken Mandadakis University of Waterloo, Waterloo, ON & Associates Dianna Leong, BSc, OD; Foresight Eyecare, Calgary, AB Erin Loewen, BSc, OD; Village Optical, Winnipeg, MB Henry Smit, OD; Derek MacDonald OD, FAAO; Ilex Eye Associates, Waterloo, ON FYidoctors Angie Machmer, OD; Emerald Park Eye Care, Emerald Park, SK Ken Mandadakis, BSc, OD; Dr. Ken Mandadakis & Associates, Toronto, ON Nohad Teliani, BSs, OD; Henry Smit, OD; FYidoctors, Truro, NS Eye Care Solutions Nohad Teliani, BSs, OD; Eye Care Solutions, Edmonton, AB Benoit Tousignant, OD, MSc, MPH, FAAO; University of Montreal, Benoit Tousignant, Montreal, QC OD, MSc, MPH, FAAO; University of Montreal EDITING WAS COMPLETED BY: Chris Hudson, BSc (Hons), PhD, MCOptom (UK), PgCUT; University of Waterloo, Waterloo, ON Derek MacDonald, OD, FAAO; Ilex Eye Associates, Waterloo, ON Tracy Murphy, MHA, CHE, Consultant, Ottawa, ON Lois Ross, Editor, Ottawa, ON DISCLOSURE STATEMENT The publication of this Guideline was made possible with an unrestricted educational grant from Optos Inc. DISCLAIMER These guidelines do not represent a standard of care. Instead, they are intended to assist the clinician in the decision-making process. Patient care and treatment should always be based on a clinician’s independent professional judgment, given the patient’s circumstances, and in compli- ance with applicable laws and regulations. The information in this guideline is current to the extent possible at the time of publication. CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017 5 C CLINICAL RESEARCH Abbreviations A1c Glycated hemoglobin IRMA Intra-retinal microvascular abnormalities AGE Advanced glycation end product MA Microaneurysms AT Artificial tears ME Macular edema BCVA Best corrected visual acuity MRI Magnetic resonance imaging CDA CPG Canadian Diabetes Association Clinical NAION Non-arteritic anterior ischemic Practice Guidelines optic neuropathy (CDA is now Diabetes Canada) NEI National Eye Institute Cataract extraction CE NPDR Nonproliferative diabetic retinopathy Clinically significant macular edema CSME NVA Neovascularization of the angle (or CSDME: clinically significant diabetic macular edema) NVD Neovascularization of the disc CWS Cotton wool spots NVE Neovascularization elsewhere DCCT Diabetes Control and Complications Trial NVG Neovascular glaucoma DED Dry eye disease NVI Neovascularization of the iris DKA Diabetic ketoacidosis OCT Optical coherence tomography DM Diabetes mellitus OGTT Oral Glucose Tolerance Test DME Diabetic macular edema OIS Ocular ischemic syndrome DR Diabetic retinopathy PDR Proliferative diabetic retinopathy DRS Diabetic Retinopathy Study PG Plasma glucose ECFV Extracellular fluid volume POAG Primary open angle glaucoma ETDRS Early Treatment Diabetic PRH Preretinal hemorrhage Retinopathy Study PRP Panretinal photocoagulation FA Fluorescein angiography PSC Posterior subcapsular cataract FAZ Foveal avascular zone RD Retinal detachment FPG Fasting plasma glucose RNFL Retinal nerve fibre layer GFR Glomerular filtration rate SLT Selective laser trabeculoplasty HE Hard exudates UKPDS United Kingdom Prospective HHS Hyperosmolar hyperglycemic state Diabetes Study IDRCS International Diabetic Retinopathy UWFA Ultra-widefield fluorescein angiography Classification System VB Venous beading IFG Impaired fasting glucose VEGF Vascular endothelial growth factor IGT Impaired glucose tolerance VH Vitreous hemorrhage IOP Intraocular pressure VMT Vitreomacular traction IRH Intra-retinal hemorrhages 6 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017 PATIENT CARE Classification, Definitions, Risk Factors DEFINITION OF DIABETES Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action, or both.1 The chronic hyperglycemia of diabetes is associated with microvascular complications affecting the eyes, kidneys and nerves, and an increased risk for cardiovascular disease. The criteria for diagnosing diabetes are based on thresholds of glycemia that are associated with microvascular disease, particu- larly retinopathy. CLASSIFICATION AND DEFINITIONS Type 1 diabetes is characterized by the destruction of beta cells in the pancreas. Although the etiology of beta cell destruction cannot be established in all cases, it is often the result of an autoimmune process. This usually leads to severe insulin deficiency and the patient is prone to develop diabetic ketoacidosis (DKA). DKA is an accumulation of ketones
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