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. month#:~:text=November%20is%20National%20Diabetes%20Month,to%20bring%20attention %20to%20diabetes

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

Leave a Reply

Updated COVID-19 and VOSH Humanitarian Clinics Advice

VOSH/International recently consulted its US and International Chapters about the feasibility and timing to restart our humanitarian clinics. While the vaccination process continues with different levels of success depending on availability and acceptance, it is evident that vaccine inequity and the availability and reliability of data in several countries are issues we need to consider.

Even if already vaccinated and boosted, our chapters are still concerned about the wellbeing of our volunteers and patients.  Some chapters, are organizing clinics locally where they are better able to comply with the existing safety requirements and respective state/country regulations.

The COVID-19 pandemic and its variants are being experienced quite differently depending on state, region, country, vaccine availability, vaccine acceptance, and the spread of SARS-COV-2 variants. Most VOSH chapters are not holding clinics or traveling internationally in 2021 or 2022.

If a VOSH Chapter choses to hold a clinic or travel internationally, we highly recommend that the chapter performs due diligence to comply fully with the requirements established by the visited country, ensures all VOSH volunteers are aware of and follow strict safety guidelines and all existing protocols and regulations of the country, and keeps the principle of “do no harm” embedded in all its decision making. As always, the wellbeing and 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. VOSH chapters in specific countries are using protocols that need to be considered as well. You can download VOSH/International clinic guidelines here.

*VOSH/International is formed by autonomous US and international chapters that are fully and only responsible for their activities, fundraising and decision-making.  VOSH/International can only provide recommendations based on our best knowledge and information at the time.

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

World Health Organization:


US Government Travel Advise:

Thank you for your hard work and dedication to improving vision and eye health throughout the world.

Michael Ciszek, OD, dipl ABO, FVI

President, VOSH/International

December 2021