Richard G. Bryan, M.D., Ph.D. is a clinical associate professor of medicine at Brown Medical School. He teaches both at the medical school and at the veterans hospital in addition to his private practice. He is the president of the Rhode Island Society of Eye Physicians and Surgeons and a member of the board of the Rhode Island Medical Society. Previously, he worked in a private practice in California. Dr. Bryan is a graduate of Baylor College of Medicine for his M.D and Ph.D. degrees. He received his ophthalmology residency training at the University of Wisconsin at Madison and retina/vitreous subspecialty training at the Manhattan Eye & Ear Infirmary and Columbia University.
Q: Why is diabetic eye disease such a critical issue?
In diabetics, eye disease is one of the most common and serious problems that can lead to vision loss and even blindness if not treated. Diabetic eye disease often builds without the patient being aware there is a problem. Sometimes, the eye disease can be very advanced before any symptoms are noted. We have good treatments, but they are most effective if done early — before the patient begins to notice problems. The Centers for Disease Control and Prevention estimates that the cost to the nation in lost productivity and health care costs exceeds $500 million/year from diabetic eye disease.
There have been several problems that have limited access to eye care. First, some primary care providers have been slow to refer to eye doctors for screening, although this problem has been much improved in recent years with increasing awareness. Second, patients are not always motivated to go through the hassle of routine eye care visits. Third, there is a perception by some that eye care is not covered by insurance. Of course, it is covered for medical reasons such as diabetic screening.
Q: What steps can people with diabetes take to protect their vision?
There are two primary things that are important. First, following through with routine screening and treatment visits as scheduled is important. The American Academy of Ophthalmology recommends that Type I diabetics be screened five years after diagnosis and Type II diabetics be screened at the time of diagnosis (since diabetes may have been silently present for some time). Many of the disasters I have seen result from patients who were lost to follow-up or had delayed care for some reason and eventually showed up with severe disease. Second, control of blood sugars and blood pressure slows down the progress of diabetic disease and makes the treatments more effective.
Q: What recommendations do you have for clinicians to promote better eye health?
Clinicians who care for diabetics play a very important role in preventing blinding eye disease. The appropriate referral of diabetics for screening and follow-up care is critical. Having some kind of flag in the medical record that keeps track of eye visits can greatly improve compliance. Of course, encouragement of better blood sugar control and patient education about the complications of diabetes are necessary not only for eye disease, but also for the many other complications of this disease.
Q: How can local communities support better eye health?
Public education on the importance of eye exams as part of an overall health maintenance plan can be very effective. There is a perception among some patients that eye care is about glasses/contact lenses and is separate from the primary care visits that are important for health maintenance.
Q: Anything else you’d like to share with the QIO News audience?
General ophthalmologists, optometrists, and even remote exams with telemedicine (in areas with a lack of qualified providers) are all appropriate screening providers and can follow patients with early disease, but there is a subspecialty within ophthalmology that specializes in the medical and surgical treatment of eye disease — the retina specialist. There have been tremendous advances in the treatment of diabetic eye disease over the last 10 to 15 years, enabling us to treat patients who would have lost vision in the past. These include both medical and surgical techniques. These advances have been able to save the sight of many patients.