Optometrist Perspective by Harvey Yamamoto, OD

Harvey Yamamoto, ODSince I became an eyecare practitioner some 40+ years ago my goal was to somehow be in a position to aide patients stricken with Diabetes and Macular Degeneration.  I began to attend as many conferences as I could on the topic until I began to slowly digest the cause and effect.  In those days, no cure was on the horizon.  Only doom and gloom.

I recall attending a seminar given in a hospital in Santa Monica.  I had driven 60 miles to attend a lecture on diabetes given by a world renowned physician.  At the conclusion of the 6 hours, the main theme of his lecture was diet, diet, diet, diet, and more dieting.  At first, I thought it was some kind of joke but over the years of being in practice I have come to the realization that the physician was spot on in his conclusion.  He told the small gathering of eyecare practitioners that he had failed in his lifelong pursuit of attempting to get his diabetic patients to overcome their disease.  I listened intently as he concluded that many of his patients had ended up with kidney failure, loss of limb, & blindness.

I drove back to my humble home and became somewhat depressed.  I purchased many books on the subject matter and began my study in earnest.  I concluded that patients needed to be trained on proper and healthful eating habits in order to control the intake of glucose.  It appeared simple enough so I embarked on a long journey that has taken me full circle.  Getting my patients to adhere to a healthy lifestyle was not as easy as it was on paper.  No, in fact, I was not all that successful until I purchased a digital retinal camera some 8 years ago.

Retinal Camera: Confucius says, “One picture is worth a thousand words.”  I was so impressed with the quickness and clarity of the digital photos that I put my Polaroid camera equipment into storage. I had the pictures piped into my exam room where the patient could view their fundus images on a large LCD TV screen.  Patients began to pay attention to what they could see.  It was the ‘wow’ factor that I had wanted for all these years.  Teaching patients became much easier.  For the first time, our patients were able to see the formation of cataracts, ONH, Hemorrhages, A/V nicking, arteriosclerosis, & many other retinal abnormalities.  I had found my magical hammer to illustrate my rules to healthful living.

I began many years ago to encourage patients with terminal macular degeneration to change their eating habits to include more vegetables.  It was not an easy task to do as most of my patients had become carnivorous over the years as their living standards had improved.  Those who listened and were willing to change their lifestyle soon discovered tremendous improvements to their health and eyesight.  I was invited to church gatherings to lecture on nutrition and eyesight. The two topics went hand in hand.  Over the past 40 years, I have averaged one sermon a month on diet, exercise & healthful living.

It pleases me to see numerous eyecare periodicals with nutrition playing a valuable role in eyesight. I ask: “What took you guys so long to catch on to something so obvious.”  The CDC (Centers for Disease Control and Prevention) estimates that by the year 2030, the number of older citizens will double to 71 million.  Eye diseases, visual impairment and blindness are becoming a growing public health concern.

As the population ages, we will see more chronic systemic diseases, increased risk of CVD (cardiovascular disease), many with ocular manifestations. This creates a tremendous opportunity for optometry to make an impact by early detection in this segment of the population.  We will see more of our patients coming to see us for a diabetic exam, AMD, & glaucoma.  Thus, I plead with my readers to begin to plan on investing in the future of your practice.  If you don’t have a Digital Retinal Camera then this is a perfect time to consider putting one in your practice.  This instrument is a wonderful ‘show and tell’ instrument.  There are numerous retinal scanning lasers available today that were not available when I began practicing.

I purchased my first retinal scanning equipment in 2003.  I upgraded to a newer OCT machine in 2009.  Yes, it was bloody expensive.  Here was my thought on the subject: “Do I wait another 10 years to purchase the newer model or do I purchase one now so that I can diagnose retinal abnormalities today.”

In my practice, the incidence of diabetes has increased tremendously.  75% of my patients are Hispanic and I find that over 40% of them over the age of 50 have diabetes.  I owe it to my patients to be in a position to not put their eyesight at unnecessary risk of blindness.  We have found numerous diabetics with decreasing and unexplained sudden vision loss was due to retinal problems that the OCT machine was able to illustrate.  We are playing a pivotal role in detecting the early signs of diabetic complications with the aid of our new machine.

We encourage our patients to see their PCP for A1C tests.  An A1C of 5.7% to 6.3% indicates prediabetes, and an A1C above 6.5% indicates a diagnosis of diabetes.  The earlier that we can identify diabetics, the sooner we can begin counseling about healthful living.  Every diabetic in our practice will receive a dilated eye exam, digital retinal photo’s, & we recommend that long standing diabetics with unexplained vision loss undergo and OCT exam annually.  With OCT exams, we have found many other vision conditions: “AMD, Glaucoma, Optic atrophy, Optic neuritis, etc.”

We educate our diabetic patients to return for regular eyecare visits to reduce visual loss. Many diabetic patients do not fully understand the importance of periodic dilated fundus exams.  Our patients have no options but to submit to a full dilated exam.  We spend an enormous amount of time educating these patients and they refer their family and friends to us because we ‘care’.

It’s important to remember that optometry is an integral part of an interdisciplinary, integrated healthcare team in the management of diabetes.

AMD: Today, I feel that every potential AMD patient needs to have an annual OCT exam as part of their comprehensive eye exam.  We have uncovered many potential PVD’s, ERM (epiretinal membrane), diabetic macular edema, macular pucker, etc, etc, just by performing the OCT.  AMD is the leading cause of visual impairment and blindness in our practice amongst the older patients that we see every day.

We discuss the addition of nutrition with these patients.  We now stock products from Natural Ophthalmics for these patients’ benefits.  In the 4 years that we have been dispensing these nutrients, we have seen hundreds of patients reverse macular degeneration.  We have seen patients with 20/200 BCVA improve to 20/40+ BCVA in 15 months with these nutrients.  We have reversed hundreds of patients with cataracts with these nutrients.  There is nothing more exciting for our patients to see improvement in their BCVA.  AREDS (Age-Related Eye Disease Study) has shown that high levels of antioxidants and zinc has reduced the risk of advanced AMD and associated vision loss.

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