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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Friday, April 18, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


Standards of Care and Clinical Practice
Recommendations: Type 2 Diabetes

Last updated: July 2012

Eye Care

Clinical Practice Recommendations

Eye Care

recommendations icon Recommendations for Eye Care

  • Refer people with diabetes for a comprehensive dilated retinal examination by an ophthalmologist or optometrist:
    • at diabetes diagnosis, and
    • annually, or more or less often, as recommended by the patient’s eye professional.
  • Retinal imaging may be used to screen and monitor for retinopathy; a comprehensive eye examination is still needed to screen for and evaluate other eye problems.

People with diabetes are at lifelong risk for eye and vision problems, including diabetic retinopathy, cataracts, glaucoma, age-related macular degeneration, and blindness. Good control of glucose and blood pressure helps to prevent onset and reduce progression of diabetic retinopathy. In addition, early detection, monitoring, and treatment of retinopathy are essential to reducing the risk of blindness.

A retinal examination (i.e., a dilated fundus examination by an eye care professional or retinal imaging with interpretation by a qualified, experienced reader) should be used to detect retinopathy. Although serious vision loss due to diabetes can nearly be eliminated through timely diagnosis and treatment, only about half of all AI/AN people with diabetes receive an annual retinal examination.

Note: Women with pregestational diabetes, who either are planning a pregnancy or have become pregnant, should have a comprehensive eye examination, and be counseled on the risk of development and/or progression of diabetic retinopathy. This examination should occur in the first trimester and should be followed throughout pregnancy and for one year postpartum.

Note: Women with true gestational diabetes (GDM), however, are at very low risk for developing diabetic retinopathy during pregnancy due to the limited exposure to increased blood glucose. Therefore, retinopathy screening is not indicated in GDM.

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Resources

Tools for Clinicians and Educators

tools and resources icon Key Tools and Resources

IHS Division of Diabetes Treatment and Prevention.
Indian Health Diabetes Best Practice—Diabetes Eye Care, 2011. [PDF - 320KB]

IHS – Joslin Vision Network Teleophthalmology Program (IHS JVN). [PDF - 548KB]

  • A telemedicine program for diagnosis and management of diabetic retinopathy operating in remote, rural AI/AN health sites. Retinal images obtained for patients at these sites are transmitted to a national reading center for validated interpretation. The IHS JVN program has been very effective in meeting the standard of care for diabetic retinopathy surveillance and bringing high-risk patients to timely treatment for the prevention of vision loss.

American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern: Diabetic Retinopathy. San Francisco (CA): American Academy of Ophthalmology. 2008. Exit Disclaimer: You Are Leaving www.ihs.gov

American Optometric Association. Optometric Clinical Practice Guideline Care of the Patient with Diabetes Mellitus. Reference Guide for Clinicians. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  St. Louis (MO): American Optometric Association. 2009. 74 p.

Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy: review article. Exit Disclaimer: You Are Leaving www.ihs.gov N Engl J Med. 2012 Mar 29; 366:1227-39.

Prevent Blindness America, National Eye Institute, Johns Hopkins University. Vision problems in the U.S.: prevalence of adult vision impairment and age-related eye disease in America. Exit Disclaimer: You Are Leaving www.ihs.gov June 20, 2012.

additional resources icon Additional Resources

National Diabetes Education Program. Redesigning the Health Care Team: Diabetes Prevention and Lifelong Management. Centers for Disease Control and Prevention and National Institutes of Health. 2007. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  68 p.

  • A cross-training guide to reinforce consistent diabetes messages across the four disciplines – pharmacy, podiatry, optometry, and dentistry (PPOD) -- and to promote a team approach to comprehensive diabetes care that encourages collaboration among all care providers.

National Eye Health Education Program (NEHEP). Diabetes and Healthy Eyes Toolkit. Exit Disclaimer: You Are Leaving www.ihs.gov

  • A kit designed for community health workers and health promoters, which provides information and tools to help educate people about diabetic eye disease in small group settings. It contains a step-by-step module, a flipchart, DVD, and other resources. NIH Publication No. 10-7363. 2010.

National Eye Institute. See Well for a Lifetime: An Educational Series on Vision & Aging (Toolkit). Exit Disclaimer: You Are Leaving www.ihs.gov

  • The Toolkit conveys science-based, easy-to-understand information about eye health, common vision changes associated with aging, age-related eye diseases and conditions, and the importance of comprehensive dilated eye exams.
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Patient Education Materials

National Eye Institute.

National Institute of Diabetes and Digestive and Kidney Diseases. Prevent Diabetes Problems: Keep Your Eyes Healthy. NIH Publication No. 09–4279. 2008.

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Bibliography

American Academy of Ophthalmology Retina Panel. Preferred practice pattern: diabetic retinopathy. Exit Disclaimer: You Are Leaving www.ihs.gov San Francisco (CA): American Academy of Ophthalmology; 2008.

American Optometric Association. Optometric clinical practice guideline care of the patient with diabetes mellitus: reference guide for clinicians. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  St. Louis (MO): American Optometric Association;2009. 74 p.

Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy: review article. Exit Disclaimer: You Are Leaving www.ihs.gov N Engl J Med. 2012 Mar 29; 366:1227-39.

Caroll M, Cullen T, Ferguson S, Hogge N, Horton M, Kokesh J. Innovation in Indian healthcare: using health information technology to achieve health equity for American Indian and Alaska Native populations. Exit Disclaimer: You Are Leaving www.ihs.gov Perspect Health Inf Manag. 2011 Winter:1-9.

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus 10 years after the Diabetes Control and Complications Trial. Exit Disclaimer: You Are Leaving www.ihs.gov Arch Ophthalmol. 2008;126:1707-15.

Fong DS, Aiello LP, Ferris FL 3rd, Klein R. Diabetic retinopathy: technical review. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  Diabetes Care. 2004;27(10):2540-53.

Gómez-Ulla F, Fernandez MI, Gonzalez F, Rey P, Rodriguez M, Rodriguez-Cid MJ, et al. Digital retinal images and teleophthalmology for detecting and grading diabetic retinopathy. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  Diabetes Care. 2002;25(8):1384-9.

Prevent Blindness America, National Eye Institute, Johns Hopkins University. Vision problems in the U.S.: prevalence of adult vision impairment and age-related eye disease in America. Exit Disclaimer: You Are Leaving www.ihs.gov June 20, 2012.

Wilson C, Horton M, Cavallerano J, Aiello LM. Addition of primary care-based retinal imaging technology to an existing eye care professional referral program increased the rate of surveillance and treatment of diabetic retinopathy. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  Diabetes Care. 2005; 28:318-22.

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Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov