Diabetes and the Canadian Optometrist

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Diabetes and the Canadian Optometrist

• Presented by
• Richard Lee BSc OD

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Diabetes Mortality

• Three million Canadians will be living with
  diabetes by the end of this decade.
• Diabetes contributes to the death of 41,500
  Canadians each year.
• Type 2 diabetes shortens life expectancy by 5-10
  years.

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Diabetes Morbidity

• Diabetes doubles the risk of stroke.
• Diabetes quadruples the risk of heart disease.
• Diabetes is the leading cause of non-traumatic
  lower extremity amputations.
• Diabetes causes 33 of the new cases of end stage
  renal disease.
• Diabetes is the leading cause of blindness in
  adults aged 25-75.

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Topics

• Relations with CDA
• Relations with family Physicians
• Clinical Practice Guidelines
• CAO position paper
• Optometric research
• Practice resources
• Medicare coverage for diabetics
• Telemedicine
• Public awareness
• Federal Aboriginal Projects

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Committee Members

• Dr. Garry Best
• Dr. Michael Dennis
• Dr. Richard Lee
• Dr. Henry Smit CAO liaison
• Mr. Glenn Campbell ex-officio member

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Diabetes Committee

• Struck in October 2006
• Terms of Reference
• promote optometrys role in the care of patients
  with diabetes, maintain relations with CDA at a
  national level, assist provincial associations
  and individual members in activities with CDA,
  promote and comment on government and stakeholder
  policy related to diabetes

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Canadian Diabetes Association

• Mission Statement
• To promote the health of Canadians through
  diabetes research, education, service and
  advocacy.
• clinical and scientific section
• diabetes educator section

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Canadian Diabetes Association

• Charles Best forms the Diabetic Association of
  Toronto 1940ish
• Canadian Diabetic Association 1953
• Canadian Diabetes Association 1979
• 12 Board Members
• 2 Senior Vice Presidents
• 7 Vice Presidents
• 5 Executive Directors
• 4 Field Offices
• 23 Regional Offices
• 150 Branches
• 4 Councils
• 16 Committees

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CDA website

• the CDA website was found to be fairly well
  balanced in the information on eye care with the
  use of generic terms such as eye doctor
• optometrist was not in the diabetes dictionary
  however ophthalmologist was
• the CDA webmaster will be adding a definition in
  the new year
• we suggested the CNIB definition to maintain
  consistent language
• michael.mella_at_diabetes .ca

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CDA Publications
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CDA Publications
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CDA Publications
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Optometry Defined
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Canadian Diabetes AssociationRecommendations

• appoint a provincial diabetes liaison person to
  meet
• regularly with CDA representatives AGMs,
  CDA Expos
• create a diabetes chat room on our CAO members
  website for sharing information on diabetes
  related matters
• encourage members to support their local CDA
  branch by providing patients with diabetes a
  membership form for the CDA with the particular
  practice coordinates on it

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Clinical Practice Guidelines 2008

• commented on 4/37 chapters for external review
• visual acuity should be listed as a component of
  the examination of the eyes
• initial examination of the fundi should be
  performed by an optometrist or ophthalmologist
  and not by a family physician
• we supported assessment of retinopathy through
  dilated pupils as the standard of care
• expert professional should be clarified and
  replaced with optometrist or ophthalmologist

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Clinical Practice Guidelines 2008

• optometrists are listed as a referral by the PCP
  after an initial visit to the PCP
• telemedicine is being evaluated in screening for
  diabetic retinopathy in communities where access
  to ophthalmic care is limited
• CPGs will be released in spring 2008
• possible change if no diabetic retinopathy in
  people with type 2 diabetes review 1-2 years.

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Retasure teleophthalmology
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Clinical Practice Guidelines Recommendations

• make PCPs , DEs, peadtricians and internists
  aware that we are on the referral list and that
  we have telemedicine in our offices for
  photodocumentation
• start preparing now for the next revision
• make available to diabetes committee members a
  literature data base of peer reviewed journal
  articles on diabetes and its ocular effects and
  treatment so that we can provide evidence based
  statements/policies
• follow developments in and studies on
  teleophthalmology
• contact Dr. Vincent Woo to have the retinopathy
  section printed in the Canadian Journal of
  Optometry perhaps with a guest editorial

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Clinical and Scientific Section CDA

• Executive Committee
• provide a clinical perspective and feedback on
  current issues involving CDA
• serve on committees and act as committee liaison
  participants in areas such as advocacy, research,
  camps, nutrition, clinical practice guidelines
  etc.
• two face to face meetings per year
• two to four conference calls per year
• Dr. Christopher Hudson nomination

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Clinical and Scientific Section CDA Recommendation

• re-nominate Dr. Christopher Hudson
• promote membership in the CSS of CDA to our
  members

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Diabetic Educators

• diabetic educators VIPs
• Arlene Kuntz BSP , acting chair Diabetes
  Educators Section
• meet your educators and communicate with them
  regularly
• The Canadian Diabetes Educator Certification
  Board
• registration with an eligible
  professional
  regulatory body
• worked 800 hours in diabetes education
• cdecb_at_sympatico.ca

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CDA/CSEM Annual Meeting

• Vancouver October 24-27, 2007
• objectives
• meet key persons in the CDA and arrange for
  further communication
• to make all health professionals aware of CAOs
  diabetes committee
• to identify opportunities for optometry to
  educate the 2500 attendees of optometrys role in
  the care of the person with diabetes
• to find out the structure of CDA

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CDA/CSEM Annual Meeting

• key persons contacted
• Mr. Garth Herbert, Chair, Board of Directors ,
  Canadian Diabetes Association
• Ms. Donna Lillie, Senior Vice President,
  Research, Professional Conference and Government
  Affairs.
• Dr. Vincent Woo, Chair Clinical Practice
  Guidelines Review Committee

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CDA/CSEM Annual Meeting

• recommendations
• have an optometrist present a poster in 2009 (Dec
  7)
• arrange a photo-op with Mr. Garth Hebert, Arlene
  Kuntz and Dr. Len Koltun to announce the diabetes
  committee and print it in the Diabetes
  Communicator which reaches the diabetic
  educators.
• consider a CAO booth at the 2008 CDA/CSEM Annual
  Meeting in Montreal with retinal camera?
• Alison Armstrong, Manager National Conferences
• alison.armstrong_at_diabetes.ca

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Medicare

• New Brunswick - none
• Manitoba prn 35/18.55
• British Columbia 19-64yrs q6mos 44.83
• Nova Scotia -coverage
• Newfoundland
• Alberta -
• Saskatchewan First Nations patients 59.55
• Ontario-
• Prince Edward Island
• Quebec general coverage 17-65yrs

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Core Document

• a work in progress
• under second revision
• Canadian document
• complete with algorithm
• highlights the optometrists role in the care of
  the person with diabetes
• recommend the final draft be reviewed by an OD,
  PhD Dr Christopher Hudson

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Closing Remarks

• two prong approach national and grass roots
• communication is the key
• thank-you for your confidence in our committee