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ODs must assume a key role in evaluation, treatment of systemic disease
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PHILADELPHIA – Optometrists must discuss systemic disease with their patients, Nicky R. Holdeman, OD, MD, FAAO, said here at the PRIMARY CARE OPTOMETRY NEWS Symposium.
In addition to increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension and prothrombotic and proinflammatory states, obesity increases the risk for major eye diseases such as age-related macular degeneration, dry eye, cataract and glaucoma, he said. Life expectancy could fall as much as 5 years for Americans if the frequency of obesity is not curtailed, he said.
Metabolic syndrome is initiated by obesity, then leads to insulin resistance, hyperglycemia, hyperinsulinemia, excess insulin, dyslipidemia, increased triglycerides, then hypertension, Dr. Holdeman said. Obesity is measured by calculating body mass index (BMI), with a range of 19 to 23 being considered optimal. At this point, 65% of American adults are considered to be either obese or overweight.
The risk for developing heart disease increases by 10% for men with a BMI of greater than 23, Dr. Holdeman said. Statistics show that a majority of physicians do not discuss obesity with their patients, with 80% only recommending exercise. Each decade, 7% of muscle mass is replaced by adipose tissue, which reduces metabolism. Abdominal adipose fat increases the risk of insulin resistance, hyperlipidemia and thromboembolic events. “It is our responsibility and obligation to discuss obesity with our patients,” Dr. Holdeman said.
The risk of acquiring diabetes mellitus for those born in 2000 is 32.8% for Caucasian men and 38.5% for Caucasian women. The risk for Hispanics is even greater, at 45% for males and 53% females. “Diabetes will overwhelm the health care system in the United States,” Dr. Holdeman said. “Diabetes kills more people than breast cancer and AIDS combined.”
In reaction to this rise in systemic disease, changes have been made to the diagnosis criteria, he said. For example, a blood pressure of 120 mm Hg to 139 mm Hg/80 mm Hg to 89 mm Hg is considered pre-hypertension. “Physicians are not being aggressive at treating these diseases. The levels don’t have to be that high for there to be a problem,” Dr. Holdeman said.
Like the old adage for real estate, location, location, location, Dr. Holdeman recommends control of blood glucose, control of blood pressure and control of lipids.