Educate patients, identify those at risk for systemic diseases

Issue: May 2004

ByMichael D. DePaolis, OD, FAAO

Michael D. DePaolis, OD, FAAO [photo]
Michael D. DePaolis

Richard is a 51-year-old who I’ve had the pleasure of caring for over the past several years. He recently visited me for a routine eye examination with no real problems other than slightly blurred near vision. During the obligatory — almost mundane — review of his systemic health history, Richard informed me that he was now on anti-hypertension medications. Yes, hypertension treatment even though he had no change in his blood pressure, symptoms or cardiovascular events.

Why is Richard now being treated? Simply put: because of borderline blood pressure and more stringent management guidelines, as well as a collective effort by all health care providers to limit the impact of a variety of core systemic diseases.

More aggressive management

Indeed, we see this trend in every aspect of medicine. As we better understand disease processes — their epidemiology and sequelae — we are able to better define management protocols that call for a more aggressive approach to hypertension, dyslipidemia and diabetes. And for good reason.

Systemic hypertension is the third leading cause of death worldwide. Elevated cholesterol can increase the risk of myocardial infarction by about 40% in at-risk males and almost double the risk for stroke-related deaths. Diabetes, which affects nearly 20 million Americans, remains the leading cause of blindness among working adults. The cumulative impact of these diseases is staggering, not just in terms of morbidity and mortality, but with respect to health care costs as well. This is precisely why their management guidelines have been revised.

Educate patients on risk

As primary eye care providers, revisions in systemic disease management can have a rather significant impact on how we practice optometry. On one hand, we can simply acknowledge these revisions and provide our patients with a vote of confidence. On the other hand, we can become an active proponent for change — educating patients and being ever vigilant in our efforts to identify those at risk.

This can entail performing in-office blood pressure measurements and scrutinizing retinal arteriovenous status in our patients at risk for hypertension. Or carefully monitoring an individual with arcus senilis for retinal vascular emboli. Or routinely — and methodically — evaluating the retina in a patient with a history of gestational diabetes. By more thoroughly attending to our patients’ ocular signs and symptoms, we are doing our best to assist the collective health care community with early detection and management.

Granted, I recognize that some of our patients may not agree with these revised guidelines, feeling as though they are being over treated. While their contention may seem reasonable, particularly if they are asymptomatic, it is our responsibility to educate patients regarding the long-term risks of unattended disease. With a bit of an explanation regarding the disease process, possible outcomes and treatment options — including diet and lifestyle modification — patients are better equipped to deal with disease. This is an important concept, as managing long-term risk is what ultimately benefits patients and health care providers alike.