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Today’s optometrist must look beyond the eye
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Just about a year ago we merged our practice with the University of Rochester’s Flaum Eye Institute. Joining forces with such a large, well respected academic institution brought about an element of change. We assumed a new electronic health records system, a variety of new office policies and a more integrated role in our patients’ overall care.
One such example involves the medical center’s policy on blood pressure (BP) monitoring. While we’ve long embraced the concept of checking BP, it was primarily done in those with a history of poor control or with retinal findings consistent with hypertension. In short, it was pretty much aimed at high-risk patients. In our new affiliation, BP measurements are part of every examination.
What I’ve learned over the past year is twofold. First, patients, to a large degree, still don’t see the link between ocular and systemic health. Many view us as their guardian of vision and not as someone who evaluates overall health. Second, there is a lot of undetected hypertension out there ... even in those without overt symptoms or ocular findings.
Even though I’ve been practicing for many years, I’m still amazed by the general public’s disconnect between ocular and systemic health. However, once educated, patients better understand the relationship and the importance of eye examinations.
It’s true of hypertension, as well as many other conditions such as diabetes and hypercholesterolemia. So, if education is the key, how are we – as a health care community – doing? The American Diabetes Association estimates that about one-fourth of the 30.3 million Americans with diabetes are actually undiagnosed (diabetes.org). American Heart Association numbers suggest that 14.5 million of the 85 million Americans with hypertension are unaware of their condition (heart.org). When considering an asymptomatic disease, such as hypercholesterolemia, the numbers are even more grim, with only one-third of the 73 million Americans with elevated low-density lipoproteins under control (cdc.gov). These are staggering numbers and a sobering reminder that our educational efforts are far from over.
Arguably, as front-line health care providers, optometrists are perfectly positioned to play a critical role in the battle against chronic systemic disease. Indeed, for certain patients we may well be the only doctor they visit with any frequency. While I may be stating the obvious here, the stakes just keep getting higher.
With an aging population, a digital device-addicted sedentary work force and skyrocketing health care costs, we can ill afford not to take a more aggressive stance. In this month’s Primary Care Optometry News, our feature article, “Blood pressure, A1c testing can help patients from ‘falling through the cracks',” provides a contemporary perspective on optometry’s role in addressing systemic disease. While I recognize this is an area of ambiguity – and maybe even outside the comfort zone for some – it is an incredibly important initiative for optometry. Identifying suspicious ocular findings, ordering labs when indicated and getting patients back to their primary care physician in a timely fashion are all part of the job. Indeed, if we truly are the guardians of vision, we must look well beyond the eye ... before it’s too late.