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Home » Eye Care Services » Diabetic Eye Exam » Dr. Lee’s Recommendations for Diabetic Patients

Dr. Lee’s Recommendations for Diabetic Patients

I’m very excited to introduce Dr. Palmer Lee and Megan Douglas from EYECenter Optometric. Dr. Lee is the managing partner and CEO of EYECenter Optometric, and they have 5 locations. He’s been in practice for 40 years and specializes in the areas of contact lenses and low vision.

Dr. Lee: Good morning everybody! First of all, a little bit of a sidebar. My first diabetic patient was my wife when she was 25 when we were married and she had been a diabetic since she was 3, so 22 years. When we got married just when glaucometers had come out until we got one and first time in 22 years of diabetes she’s able to manage her blood sugar better so the first 22 years of her life, she really ran with elevated blood sugar. She passed away at age 44, 19 years after we’re married. Huge loss and just a very difficult thing to go through but as her husband, I walked through some of the challenges of a diabetic has on a day-to-day basis. It’s just so much more than just managing the blood sugar, it’s a whole life. As an optometrist, we need to be sensitive to that. If we’re travelling and notice changes how do you accommodate that. At dinner, how do you know exactly what will be served and when they’re going serve it. How do you adjust and accommodate that? It just goes on and on. It’s a disease that takes a lot of energy and a lot of effort to manage on a day-to-day basis. But because of my experience in watching what my wife went through from having 22 years of elevated blood sugar and how that preset her condition down the road. I just have always been very sad to my diabetic patients and very caring about their process and what they go through day-to-day basis.

It’s amazing to me that we have 30.3 million Americans who have diabetes. That’s 9.4% of our population. Not many decades ago it was 4.7% of our population, so it’s doubled over the last several decades. Most diseases were able to start to eliminate and this is growing. In my age range, in the group of 65 years of age or older, ⅓ of every person has diabetes. So ⅓ of your patients of 65 years or older is dealing with diabetes. That’s staggering when you think about it.

So how do we deal with that in our office because it’s a part of each one of our practices not just the EYEcenter practices but your practices as well. I’m gonna talk a little bit of what we do in our office today. First of all, when a patient checks in after they take the initial intake, we have a technician that takes them back and there’s pre-testing, and they do case history. In the case history, they will ask if they are diabetic or if they have a family history of diabetes. They will ask how long they have been diabetic if they are diabetic. Are they insulin dependent? What medications do they take for diabetes? What was their last A1C and when was that taken? What was their blood sugar this morning when they got up? So, before I go and see that patient, I wanna have a little bit of an idea of how long they’ve been a diabetic because that affects the disease process, the length of time, and then somewhat of an idea on how well they manage or they know anything about their disease. If they know their A1C’s those types of information. And I walk in and then I can start talking with them and reviewing all of these. So, diabetic eye diseases is a family of problems, and that affect people with diabetes. Includes diabetic retinopathy, diabetic macular edema, cataracts, glaucoma, just to name a few parts of the diabetes disease. Over time, these conditions can lead to poor vision and even blindness.

A diabetic is 25 times more likely to lose vision than the non-diabetic and that’s staggering, 25 times greater likelihood to lose vision. This risk can be greatly reduced by good management in disease and that I think when we come in as an optometrist to help our patients understand what the course of the disease can lead to, help them understand the importance of good management, and also be very proactive in early detection.

Early diagnosis and early treatment really leads to better vision and better quality of vision. In fact, that show us that a diabetic that has a yearly eye exam has 95% less likely to lose vision due to diabetes. And obviously it’s not the early exam but it is early detection of any retinal changes because of the disease. We need to be proactive rather than reactive. So do you explain that to your patient? Do you draw that strat? Do you let them know the importance of the yearly eye exam? Do you have a very robust recall system to make sure that they come in on a yearly basis? These are all very very important items in managing your patient, in managing the diabetic. Many of my patients I’ve seen over many years, there’s a trust that they’ve built in, they trust me with their eyes and they trust that I would do the best for them. Also, I generally have more time with my patients and their caregivers or their GP does.

My wife who passed away when she was part of an HMO plan and I would go in with her to the doctor and the typical scenario would be that we would wait an hour, an hour and a half in a crowded waiting room. We’d get in, the doctor he/she would be very very bright but they had 5 minutes with us, they would review the blood panel “You’re doing good here. Not doing good here, well change this and do that.” that would be kind of it. Then would now move on to the next patient. And I remember sitting there thinking “I wanna do better with my patients than this.” They were smart, just did not have the time to invest in really explaining the disease. They just kind of manage the drugs and insulin, and just reviewed the generalities. And I just feel like our patients, they need more than that. So first, our patients have trust but also they have more time with us and these are 2 ingredients that I feel need to be used wisely with the patient. I use time with my patients to explain how elevated blood sugars can affect the eye. I try to do it in layman terms, in ways that they might understand. For example, I might take their A1C and will tell them like if they have an A1C of 7 that’s like travelling 70 miles an hour down the freeway, it’s pretty safe. You’re probably not getting an accident, you’re gonna go with the flow, you’re gonna do just fine. If you have an A1C of 10, that’s like driving 100 miles per hour down the freeway. Now all of us probably have driven a 100 miles per hour in a really short period of time, you can slow down and manage that but if you try to drive a 100 miles an hour on the freeway all the time you’re gonna eventually crash and burn, and it’s going to create huge issues and problems. And that’s the same as writing an A1C of 10 for a long period of time. Might be a little simplistic but they seem to understand that. I have to say that my patients seem to be thankful and appreciative of the time that I spend with them. You think about it, most of us have 20 – 40 minutes with the patient depending on how you book your patients.

With modern technology, refractions just take very few minutes. We really have probably at least 15 – 30 minutes to really talk with the patient and really explain, to go in-depth and that is priceless and valuable. So, in terms of A1C, we don’t measure A1C at present. We just test driving this in one of our offices and see how we can integrate it into the EYECenter family of things that we do. But we definitely talk to them about that and if the patient doesn’t know why they went to see us, we’ll explain the importance of it and we have them call us back with that information so we can get it in the records and document it. If there’s questions on that we might call them back and talk to them about that as well. We certainly make sure that we send the report to the primary eye care, primary doctor, as well as the copy of the retinal photo.

Using technology, it is amazing today from when I was practicing 40+ years ago to where we are today. Certainly, when I start practicing we dilate the patient, look inside but now we have technology that really allows us to do a phenomenal job at caring for our patients. The OCT allows us to look further down into the layers below the surface of the eye. Retinal Imaging helps us document what we see as well and it gives us a wide view of everything. Sometimes we can’t like most insurances, we can’t build for example OCT unless we have a medical diagnosis and you may not have that. Unless you find it after you do it but I firmly believe you have to do what’s right for the patient. You can’t just always look at “Can I build this procedure?” You’re caring for that patient and you have to do what’s right for them. So, these things are just really key to early detection. Again, if you look back at the numbers and realize that diabetes is the leading cause of blindness today and how you can affect that number in health is early detection so you can make it change there. The other day I had the head of the internal medicine department of a local hospital come in as a patient and she was sharing with me that they really do not get copies of retinal imaging from the optometrists and some of them don’t even get reports. So, they are looking at retinal imaging in the clinic because they want this, they want to be able to see that. Now that’s sad, because most of us do this already and it’s so easy to copy that onto their primary doctor so they can have that in their records. I truly believe that you do that, the referrals will pour in to you because you’re doing something that is differentiate you from other doctors out there because they are not getting it, they really aren’t. I have a GP that is across the street. That’s where I go to for my yearly physical. So, last time I went in and I noticed that I haven’t really gotten a lot of referrals from him to managing his diabetic patients but I said “You know you really need to come in and I’m gonna give you a just a complimentary eye exam.” and so he did and with that I walkthrough all the stuff that we do and showed him the technology. He was really wowed and didn’t realize the scope of we optometrist do and the technology that we have to access. So, since then he referred a lot of patients in.

I would just encourage you to reach out to the doctors in your community and show them what you do whether it’s through sending reports and records or whether it’s to bring them in. Actually physically walk them through and let them know what we can do because it’s very impressive and they’re very impressed with that.

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