Champlain LHIN. Estimated that 55,563 people over age 18 live with diabetes

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Bernard Thornton
6 years ago
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1 Champlain LHIN Estimated that 55,563 people over age 18 live with diabetes Healthy, caring communities supported by health services of choice that achieve results- today and for the future

2 Impact of Diabetes People with Diabetes Account For: 56% of lower limb amputations 1 59% of retinal surgeries 1 43% of dialysis treatment 2 32% of coronary bypass procedures 1 23% of cataract surgeries 2 27% of angioplasty cases 2 Main cause of blindness among those aged BC Data: Dr. Ballem. Nov Presentation: Optimizing Opportunities: Improved Chronic Disease Prevention and Management in the North West LHIN. 2 Champlain LHIN. 3 Institute of Clinical and Evaluative Sciences Diabetes in Ontario

3 Retinopathy screening in the Champlain LINH 1 in 3 people with diabetes in the Champlain LINH have not received an eye exam in the past 2 years Early detection and treatment of retinopathy are essential to prevent blindness in patients who have diabetes

4 Case 63 y.o. woman presents with symptoms of polyuria and polydipsia. PMHx: Obesity and Hypertension Diagnosed with diabetes by FBS = 13.0 & HbA1c = 8.5% She is referred to a community diabetes education program for diabetes education and started on Metformin. You recognize the need for complication screening and want to arrange for retinopathy screening.

5 But you have a number of questions. Who can you send your patient to ensure retinopathy screening in a timely way? What type of exam is required? Do all eye specialists provide the appropriate type of screening? Does my patient have to pay for this service? How can I facilitate the communication between eye specialists, myself, and the patient s other caregivers?

6 Diabetic Eye Disease: Ensuring our patients are adequately screened Sherif El-Defrawy MD PhD FRCSC Co-Chair, Eye Health Council of Ontario

7 Disclosure No financial interest in anything discussed in this talk

8 Objectives Through attending this session, participants will be able to: Describe the current concerns regarding screening for diabetes related eye disease Explain the recently released guidelines for retinopathy assessment related to referral and follow-up Discuss with patients the assessment process and the costs that are covered and not covered by OHIP Use the form designed to increase the communication between health care providers

9 The Collaboration Why 3 Logos Diabetes Regional Coordinating Centre (DRCC) Office of CME, Faculty of Medicine Eye Health Council of Ontario (EHCO) What is the Council Recommendations later in the presentation

10 Eye Health Council of Ontario (EHCO) A forum created by Ophthalmology and Optometry to serve patients through a unified voice for eye health care issues. Representation from the academic, political and regulatory arms of the two professions and MOH Opportunity for all stakeholders to play a role regularly

11 Optician/Optometrist/Ophthalmologist Opticians: Opticians are regulated health professionals High school diploma and 2 year college program Dispense ophthalmic eye wear (eyeglasses, contact lenses and low vision devices) to the public based on a prescription from an optometrist or physician 2400 in Ontario

12 Optician/Optometrist/Ophthalmologist Optometrists: Optometrists are regulated health professionals 4-year University post graduate degree program Lectures and clinical training experience in visual system, optics, and ocular diseases. Prescribe and sometimes dispense ophthalmic eyewear Can diagnose eye disease and manage certain eye diseases Able to prescribe medication in Ontario 1800 in Ontario

13 Optician/Optometrist/Ophthalmologist Ophthalmologists: Physicians 4-year MD followed by a 5 year residency in ophthalmology and often a 1-2 year fellowship in a subspecialty. Diagnose eye diseases and provide medical and surgical treatment Many still provide routine examinations and prescriptions for eyeglasses (although those numbers are decreasing) 450 in Ontario

Diabetes And The Eye Hyperglycemia endothelial damage: loss of barrier function and leakage from vessels capillary fallout non-perfusion Retinal

14 Diabetes And The Eye Hyperglycemia endothelial damage: loss of barrier function and leakage from vessels capillary fallout non-perfusion Retinal hemorrhages, exudates, edema and ischemia Ischemia results in new, incompetent blood vessel formation Retinal and vitreous hemorrhages Retinal detachments.

15 Treatment of Diabetic Retinopathy Intravitreal injection Laser Vitrectomy

16 The Eye Examination Vision assessment

17 The Eye Examination Pupillary and motility assessment Visual field and color vision

18 The Eye Examination Slit lamp examination Anterior segment exam Intraocular pressure Glaucoma Magnified stereoscopic exam of the optic nerve head and macula

19 The Eye Examination Indirect ophthalmoscopy Examination of the peripheral retina

20 The Eye Examination Optical coherence tomography (OCT)

21 EHCO Recommendations For Primary Health Care Providers Ask at every visit about last visit to an optometrist or ophthalmologist Refer all newly diagnosed patients with type II diabetes to an optometrist (or ophthalmologist) for retinal assessment. Patients with type I diabetes should be assessed within 5 years of diagnosis.

22 Options For Referral For Retinal Assessment Facts about numbers in the region: Optometrists 87 Ophthalmologists - 56 For yearly retinal assessment, there should be no cost to patient when they go to either an optometrist or ophthalmologist, unless patient chooses optional aspects of the exam When referring patients for a retinal assessment, ask the optometry or ophthalmology office:..will you do a major eye exam for patients who are diabetic at no cost to patients? Ophthalmologists and optometrists should provide a yearly update to primary health care provider

23 EHCO Recommendations For Primary Health Care Providers Pediatric patients with Type 1 Diabetes: Refer for a comprehensive eye examination once the child has reached the age of 10, or has had diabetes for 3 years. An ophthalmologist should perform this initial examination. At age of 13, in the absence of retinopathy, the patient should be followed by an optometrist (or ophthalmologist) on an annual basis.

24 EHCO Recommendations For Primary Health Care Providers Pregnant women with diabetes: Before attempting to become pregnant, women with Type 1 or Type 2 Diabetes should undergo an ophthalmic evaluation by an optometrist or ophthalmologist. Repeat assessments should be performed during the first trimester, as needed during pregnancy, and again within the first year postpartum. This guideline does not apply to women who develop gestational diabetes, because such individuals are not at increased risk for diabetic retinopathy.

25 To Make Things Easier Use the Diabetic Checklist to keep track of patient status Remind patients about their diabetic passport See list of Optometrists in your area Use Eye Health referral/consult template for referrals to optometrists and ophthalmologists Or revise your present form with the recommended critical components. (note be sure to insert a request for a report following assessment or treatment)

29 Diabetes Passport My Diabetes Passport enables the client to record when they had their last retinal eye exam.

30 What happens if the assessment detects problem? Intravitreal injection Laser Vitrectomy

31 What does it cost patients to have retinal assessment? For yearly retinal assessment, there should be no cost to patient when they go to either an optometrist or ophthalmologist, unless patient chooses optional aspects of the exam

32 What are potential additional costs? Optometrists or ophthalmologists may offer additional services to patients that are not covered by OHIP. These include: a photo record of the retinal assessment Optometrists may charge a fee if the patient is between and the primary reason for the visit is a refraction (new glasses) The cost for these services vary and patients should clarify the specific details with their eye care provider

33 Reasons why there may be confusion OHIP covered major eye examinations for everyone up until 2004 For patients 20-64, there is a fee for an eye examination if the patient has no eye disease (routine assessment and glasses prescription) College of Optometry recommends services during a major eye exam that are not considered essential by OHIP and are not covered If, during a routine eye exam there is evidence of undiagnosed diabetes : the eye exam will still not be covered for optometry until the patient has been diagnosed by a physician It will be covered for ophthalmology

34 Closing - summary Ask at every visit about last visit to an optometrist or ophthalmologist Refer all newly diagnosed patients to an optometrist (or ophthalmologist) for retinal assessment. Use referral form for all referrals with name and fax clearly visible with request for results. Ensure patients follow-up care is overseen by their eye health provider

Speaker Disclosure Statement. " Dr. Tim Maillet and Dr. Vladimir Kozousek have no conflicts of interest to disclose.

Speaker Disclosure Statement. Dr. Tim Maillet and Dr. Vladimir Kozousek have no conflicts of interest to disclose. Speaker Disclosure Statement Dr. Tim Maillet and Dr. Vladimir Kozousek have no conflicts of interest to disclose. Diabetes Morbidity Diabetes doubles the risk of stroke. Diabetes quadruples the risk of