President’s Insights November 2020

This November has been National Diabetes Month in the United States and November 14th was World Diabetes Day. This is a great time to focus on diabetes and how it affects the lives and vision of our patients.

As vision volunteers and optometrists, we know that diabetes adversely affects the small blood vessels in the human body, and there are a lot of small blood vessels in the retina. In fact, the retina is the one unique place in the body where we can get a real-time glimpse at the small blood vessels in action. Either through dilation of the pupil and looking in with a lens or using a non-mydriatic camera we can see the retina at work. Poorly controlled or uncontrolled diabetes will cause micro-aneurysms, leaking capillaries, and retinal hemorrhage leading to visual impairment and blindness if not prevented or treated.

Perhaps even more importantly, if the retina is in trouble, the brain, heart, kidneys, and peripheral vasculature in the feet will also be in trouble. So, in this way, the eyes truly give a privileged and unique insight into the health of the rest of the body.

We know that blood sugars can be dangerously high even when the patient feels fine. Many people with diabetes can be quite unaware of the risk of poorly controlled diabetes until they visit an eye clinic when the retinal changes are detected. In that way, a vision care volunteer or optometrist might be the first health care provider to come into contact with a person with diabetes. It is important to educate the patient about the risks of diabetes along with a trusted family member to assist in diabetes prevention. This is a wonderful opportunity to interact with other health care providers such as health promoters (promotoras), dieticians, nurses, primary care physicians, and internists to help make lifestyle and nutrition changes for the better.

The World Health Organization’s World Report on Vision shows that diabetic retinopathy is responsible for the blindness or visually impairment in at least 3 million people worldwide. Uncorrected refractive error and cataracts cause the most visual impairment and blindness, that is true, but while examining the eyes it is important identify all risks to the eyes and vision, and diabetic retinopathy is something we would not want to miss. It’s also important to remember that poorly controlled diabetes is a major risk factor for posterior sub-capsular cataracts, so be on the lookout for this special type of cataract. We recommend an annual eye exam for all people with diabetes because it is much better to prevent eye disease, when possible, and treat the effects of diabetes in the eye early rather than later.

For more information on diabetes and its effects, or how to prevent diabetes, please see these sources of information.

https://worlddiabetesday.org/

https://www.niddk.nih.gov/health-information/community-health-outreach/national-diabetes- month#:~:text=November%20is%20National%20Diabetes%20Month,to%20bring%20attention %20to%20diabetes

https://www.who.int/publications/i/item/world-report-on-vision

J. Daniel Twelker, OD, PhD, FAAO, FVI
President, VOSH/International

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Updated COVID-19 and VOSH Humanitarian Clinics Advice

Due to an unprecedented surge in COVID-19 infections, a new variant that is more contagious, and these being early days in the vaccination distribution, VOSH/International DOES NOT recommend that chapters participate in domestic or international eye and vision clinics at this time.

We reiterate that at a time when the coronavirus continues to spread quickly in many parts of the world and vaccinations are not yet available to local populations, the risk of close contact with patients in a crowded outpatient environment remains high.

If a VOSH Chapter or VOSH volunteer chooses to hold a clinic against our best guidance, this is done at your own risk, by your own decision and should be in line with current local/national government rules.  VOSH/International would like to reiterate that safety for VOSH volunteers and our patients is of utmost importance and central to any decision-making process.

We have published our updated clinic guidelines with best practices to be observed in this new context.  You can download VOSH/International clinic guidelines here

Also please keep checking the following sites with official and most recent updates:

World Health Organisation: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

US CDC: https://www.cdc.gov/coronavirus/2019-ncov/travelers/when-to-delay-travel.html

US Government Travel Advise: https://travel.state.gov/content/travel/en/traveladvisories/COVID-19-Country-Specific-Information.html

Thank you for your patience in these unprecedented times, hard work and dedication to improving vision and eye health throughout the world.

John Daniel Twelker, OD, PhD, FAAO, FVI

President, VOSH/International

January 2021