PCON sponsors SECO course on diabetes

The lecture team will offer tips on conveying a vital message to patients who may or may not realize they are suffering from this condition.

A. Paul Chous

At this year’s SECO meeting in Atlanta, Primary Care Optometry News will sponsor a 2-hour course designed to prepare optometrists for seeing patients with diabetes.

Co-presenters A. Paul Chous, OD, MA, FAAO, and Jeffry D. Gerson, OD, FAAO, will stress the importance of effectively communicating with patients with diabetes by using positive language, avoiding scare tactics, building a relationship through knowledge and compassion, and discussing the ABCs of diabetes care (A1c, blood pressure and cholesterol) and the fear of hypoglycemia.

They will discuss how diabetes is defined using different clinical/laboratory measures, including HbA1C, and the importance of body mass index, cholesterol levels, blood pressure and IOP measurements in these patients.

They will also discuss how to handle a patient when common findings lead to a suspicion of diabetes.

Jeffry D. Gerson

In one case report Drs. Chous and Gerson will share, a 46-year-old patient came in for an eye exam due to slightly blurry vision. He said he had no systemic health problems and was taking no medications.

This patient’s visual acuity was 20/100 OD and 20/30 OS. His pupils, confrontational visual fields, Amsler grid and anterior segment were all normal. However, his fundus exam revealed widespread microaneurysms, several cotton-wool spots, vascular engorgement and crossings, and dot and flame hemorrhages in the posterior pole and equatorially. Macular edema was present in the right eye and possibly in the left.

A fluorescein angiogram was ordered and showed significant leakage in the right macula and limited change to the macula of the left eye.

Focal laser was recommended and a letter was sent to the patient’s primary care physician with the findings, recommending a blood work-up for diabetes mellitus and other vascular problems.

The presenters will provide pearls on dealing with patients who know they have diabetes but care for themselves improperly. Drs. Gerson and Chous will offer effective strategies for counseling patients making common, uninformed statements such as:

• “I have the good kind of diabetes.”
• “I don’t have to check my blood sugar because I can tell when it is high by the way I feel.”
• “My A1c test is 120.”
• “I see fine, so I am sure diabetes has not damaged my eyes.”
• “Why do you care what kind of blood pressure medicine I take?”

In another case report, a 23-year-old man with a 12-year history of type 1 diabetes mellitus came in for an eye exam because he lost vision in his right eye 3 months earlier and now his left eye is blurry.

He stopped taking his insulin 2 years earlier, substituting it with the nutritional supplement chromium picolinate. He had no eye exam for 5 years. The patient was a licensed emergency medical technician but was laid off 6 months ago and had no insurance.

His in-office HbA1C was 10.1%, his blood pressure measured 147/94 mm Hg and his IOP was 15 mm Hg OD and 15 mm Hg OS. His fundus photos showed proliferative diabetic retinopathy with vitreous hemorrhage.

The patient was referred to a retinal specialist and an endocrinologist and educated about his condition.

Dr. Chous is a consultant for dLife, adjunct faculty member at NOVA Southeastern University and owner of Chous EyeCare Associates in Tacoma, Wash. Dr. Gerson is the Kansas Optometric Association’s 2008 Young Doctor of Optometry of the Year Award Recipient and a partner in WestGlen Eyecare in Shawnee, Kan.

“Conversations in Diabetes” will be held March 2, 8:45 a.m. to 10:45 p.m. in Room A313 at the George World Congress Center in Atlanta. See the April issue for full coverage of the session. To register to attend, go to www.pconsupersite.com/SECO. – Nancy Hemphill, ELS