Screening for diabetic retinopathy: the optometrist's perspective

Diabetic retinopathy (DR) is a micro-vascular complication of diabetes affecting nearly all persons with a duration of diabetes of >= 15 years; and is the most common cause of blindness in the working-age adult population in developed countries. Vision loss results mainly from macular edema, macular capillary nonperfusion, vitreous hemorrhage, and tractional retinal detachment. Timely and appropriate care at early stages of DR can significantly reduce visual loss over time, improve patients' quality of life, and reduce the financial burden associated with the complications of visual impairment. Treatment modalities such as retinal photocoagulation, intraocular injections of pharmacological agents, and vitreo-retinal surgery have been effective in the management of DR. Optometry is a health care profession that is concerned with eyes and related structures, vision, and the visual system. Apart from refraction and visual rehabilitation, optometrists have a wide range of roles to play in DR management by performing new visual acuity tests, detecting DR early using dilated ophthalmoscopy and if required imaging modalities, monitoring disease progression, providing timely follow-up examinations and management which are critical for early diagnosis and intervention, making referral for concurrent care when indicated, and, above all, educating the patient. The optometrist's participation in the shared care of DR management regimen is likely to result in improvement in patient outcomes. This review is aimed at highlighting what primary-care optometrists are doing to manage this sight-threatening disease, what they can and should do to improve their competence in providing eye care to patients with diabetes, and what guidelines they need to follow to improve visual outcomes in the management of DR and diabetes mellitus.