By Dorothy Hitchmoth, OD, FAAO, ABCMO, ABO Dipl.

As primary eyecare providers, optometrists are faced with the challenge of addressing the diverse healthcare needs of our communities.

My experience practicing in rural America made it clear to me that one strategic and important public health contribution that can significantly transform an optometry practice is an increased focus on the care of patients living with diabetes.

An intentional focus on diabetes enhances patient outcomes and has a substantial impact on the overall success and sustainability of optometry practices nationwide. Better still, it’s neither difficult nor expensive. In fact, doing it well may actually save you time, boosting your profits, and help prevent vision loss.

Here’s why focusing our efforts on diabetes management is a worthwhile endeavor for us and for our patients.

What We Can Do For Our Patients

There are several excellent, altruistic reasons to focus more of our attention on diabetic eyecare:

1. We can help tackle a growing epidemic. Diabetes has reached epidemic proportions globally, and its impact on eye health cannot be overstated. By concentrating on diabetes care, optometrists position themselves as front-line guardians against a pervasive health concern. With the prevalence of diabetes rising, the demand for specialized eyecare is more critical than ever. Optometry practices that focus on diabetes care contribute positively to public health outcomes. Actively managing diabetic eye disease by monitoring both the structure and function of the visual system enables us to play a crucial role in preventing vision loss and improving overall patient well-being. This commitment to public health can enhance our practice’s reputation and community standing.
2. We can help address health disparities. Health equity is everyone’s responsibility, and the need for diabetic eyecare services is pronounced. For example, the Latino/Hispanic population is more likely to develop diabetes-related complications, often has a higher mortality rate and receives lower-quality healthcare compared to mainstream groups.1 Geography likewise contributes to inequities in diabetes-related care. A recent analysis of more than 28 million eye exams performed by U.S. optometrists and ophthalmologists showed a significant geographic gap in care and provider coverage in counties with lower median household incomes, higher poverty rates and fewer high school graduates.2
3. We can elevate standards of care. In 2023, I joined several colleagues in authoring a consensus document on the assessment and management of diabetic retinopathy management in optometry.3 Me and the other members of the task force have a singular purpose: to elevate the standard of care to avoid preventable vision loss. We developed a framework structured around five guidelines that clarify best practices in detection, grading, risk assessment, management and patient support. More recently, we issued a call for comment from the optometric community to help ensure that the guidance represents the voice of our profession. 

What We Can Do For Our Practices

1. We can reap the rewards of supply and demand. Diabetes care can be financially rewarding for optometry practices. With a growing population of people with diabetes, there is a consistent demand for specialized eyecare services. Moreover, the establishment of long-term patient relationships ensures a steady stream of revenue, contributing to the financial viability and sustainability of our practices. Income generation stems from diagnostic testing, such as OCT and ERG, as well as from nutritional supplement dispensing when appropriate from a  medical and intervention standpoint.
2. We can differentiate ourselves in a competitive landscape. Focusing on diabetes care allows optometrists to differentiate their practices. The ability to provide comprehensive eye care tailored specifically to diabetic patients can set a practice apart. Patients increasingly seek practitioners who can address their unique health challenges comprehensively and holistically.
3. We can build long-term patient relationships. Diabetes is a chronic condition that requires ongoing management and monitoring. By actively engaging in diabetes care, we can establish long-term relationships with our patients. This continuity of care  fosters patient loyalty and ensures consistent revenue for the practice over time.
4. We can participate in a collaborative care model. Diabetes care often involves collaboration with other healthcare professionals, such as primary care physicians, endocrinologists and dietitians. A practice that actively participates in a multidisciplinary approach to diabetes management becomes an integral part of a patient’s healthcare journey. This collaborative model strengthens professional networks and referrals.
5. We can receive a fair reimbursement using efficient, well-developed diagnostics. There are mechanisms for compensation for diabetes care delivery. There is a national commitment to the prevention of diabetes complications, including diabetic retinopathy, which no doubt contributes to the less restrictive coding for necessary tests. For example, when a patient presents with diabetes and uncontrolled HA1C, we can and should go beyond fundus photography and visual acuity as measures of structure and function in visually symptomatic patients. The utility of OCT in such cases cannot be understated given that we can now examine the retinal microvasculature like never before. Likewise, the electroretinography (ERG) provides an objective measure of function that is far more useful in practice than subjective visual acuity assessments. For example, a technician can collect an objective DR Score within minutes5 with a handheld RETeval, and color-coded results on a number line provide actionable data and a reimbursement of ~ $128 with the availability of more than 560 diagnostic codes.

The financial rewards and positive impact on public health make diabetes care a cornerstone for the success and sustainability of optometrists who are willing to embrace this transformative approach.

Results of Our Focus on Diabetes Care

The number of people we see with diabetes continues to increase in our practice, and has grown by 3 percent per year over the last five years as a result of the overall increase in the number of people with diabetes, the aging population in our rural location and the overall optometry and ophthalmology provider shortage. We project this number will continue at this pace for the next 10 years!

We are providing more diagnostic and supportive care for those living with diabetes than ever before because many present with the comorbidities of hypertension, glaucoma, cataracts and other ocular and systemic conditions.

The diagnostic testing to best care for these complex patients increases the revenue per visit by as much as 50 percent. There are operational costs to taking care of more complicated patients, but the overall financial yield is still in the positive compared to routine care visits.

As primary eyecare providers, we play a pivotal role in enhancing community health, particularly as it relates to elevating the standards of care in diabetic eye disease. Diabetes poses a significant threat to vision.

In the face of an increasing diabetes epidemic, alongside a shortage of eyecare and other providers, we have a unique opportunity to make a substantial impact on our communities.

References

1. Caballero AE. Transcultural diabetes care: a call for addressing the patient as a whole. Endocr Pract. 2019 Jul;25(7):766-768.
2. Bhatnagar A, Skrehot H, Ahmed M. County-Level Analysis Of Eye Exam Access and Utilization in the United States. Ophthalmic Epidemiology. 2023 May 27:1-7.
3. Modern Fundamentals of Diabetic Retinopathy Management in Optometry. Available at: https://lkc.com/resources/ebooks-reports/modern-fundamentals-of-dr/

Originally published in Review of Optometric Business.