The not-so-secret weapon of diabetes management

There’s no denying physicians and dietitians play critical roles in caring for people living with diabetes. But there’s a not-so-secret weapon patients often overlook - their optometrist.

There’s no denying physicians and dietitians play critical roles in caring for people living with diabetes. But there’s a not-so-secret weapon patients often overlook for the ability to manage eye-related issues resulting from the illness and monitor its effect on the body – their optometrist.

“Yes, we look to make sure that diabetes hasn’t impaired a patient’s vision or created other ocular issues, but there’s more to it than that. A big chunk of our job is monitoring the disease’s effects on the cardiovascular system,” stated Dr. Joshua C. Smith, President of the Ontario Association of Optometrists.

After dilating the eyes during a comprehensive eye exam, optometrists can detect abnormalities that may signal a change in the cardiovascular system. These changes can easily be missed, since family physicians and diabetes specialists typically do not conduct comprehensive eye exams.

“Optometrists examine every aspect of the eye and review the patient’s short and long-term blood glucose levels. Any change in ocular health status is communicated to the patient’s physician or diabetes specialist, and, if the change is eye-specific and requires advanced therapy, we begin the referral process to an ophthalmologist,” stated Dr. Smith. “In many cases we are the first line of defence for people living with diabetes since we are often the first ones to spot important changes that would ordinarily go unnoticed.”

These vascular changes typically present as diabetic retinopathy, a common ocular condition found among people living with diabetes. Affecting the blood vessels of the retina, this condition can lead to permanent vision loss.

“If a person is managing their diabetes effectively, meaning they are following all of the doctor’s orders, taking their medication, managing their diet and exercise regime, and coming in for regular check-ups, then the onset of retinopathy can be delayed.”

However, there’s no guarantee that patients can avoid it altogether. With diabetic retinopathy being the leading cause of blindness in working-aged North Americans, “it’s not a matter of if, but when,” states Dr. Smith. “Even though a person has their diabetes under control, there will likely come a time when an eye-related issue appears. That’s why yearly comprehensive eye examinations are the best way to catch changes in the early stages rather than later on when irreversible damage has occurred.”

The Ontario Association of Optometrists recommends everyone get annual exams with an optometrist, because, as it happens, some of the earliest signs of diabetes affect the eyes in patients who don’t know they have the disease. However, people living with diabetes may need an eye exam on a more frequent basis. Thankfully, eye exams are OHIP-covered in these cases.

In addition to looking for signs of early retinopathy in people living with diabetes, optometrists look for:

Macular edema

  • A buildup of fluid in the macula (an area found in the centre of retina), which distorts vision

Neovascularization of the optic nerve, retina or iris

  • The growth of new blood vessels found in these areas can cause vision impairment, blindness and glaucoma


  • Increases pressure in the eye and damages the optic nerve, which is responsible for transmitting images to the brain

Diabetes can be a challenging disease to manage. That’s why people living with diabetes should take advantage of every line of defence against its effects. Effective management means adding regular eye exams with an optometrist to their care regimen, since, as Dr. Smith put it, “we can see things you and your family physician cannot.”

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