/ /

  • linkedin
  • Increase Font
  • Sharebar

    How diabetes affects contact lens wear

    Keep A1C in mind and watch for corneal erosions

    Mass media and medical publications have been warning for years that the incidence of diabetes is rising rapidly and predicting a “health catastrophe” in which more than 10 percent of the U.S. population would be living with this disease.1 The future looks even worse with statistics showing that the rate of prediabetes has been climbing even faster than predicted2 and that without significant lifestyle changes, most people with prediabetes condition will develop type 2 diabetes within 10 years.3,4

    If diabetes-related problems are soon to become the reason for nearly 90 percent of patient visits to U.S. physicians, as has been suggested, then optometrists will be seeing many more of these cases.4 But optometrists should be expanding their management beyond checking patients for signs of diabetic retinopathy.

    More contact lenses: 4 things you need to know about contact lens dropout

    Diabetes and dry eye

    “There are distinct evidence-based reasons why we should be looking at the ocular surface,” said Milton M. Hom, OD, FAAO, who is in private practice in Azusa, CA, and a member of Optometry Times Editorial Advisory Board. He spoke at the SECO 2016 meeting in Atlanta.

    According to Dr. Hom, studies have shown that half of patients with type 2 diabetes also have dry eye symptoms and that the higher the hemoglobin A1C (HBA1C) values, the higher the rate of dry eye syndrome.5

    The association may be linked to automatic neuropathy, which decreases corneal sensitivity and affects feedback mechanisms and lacrimal gland secretion. In addition, hyperglycemia impairs inflammatory cell function and raises the risk of corneal infection.

    Patients with diabetes are also at risk of endothelial cell loss, impaired sensitivity, and recurrent corneal abrasions.

    “The diabetic endothelium is morphologically abnormal,” Dr. Hom said.

    More contact lenses: JJVC discontinues UPP

    To better address the host of eye-related risks associated with diabetes, Dr. Hom divides his management of these patients into two categories addressed in separate visits: one for the standard diabetic exam and one for ocular surface problems. During the ocular surface exam, measurement of HBA1C is standard. These readings can offer a more accurate picture of the disease status than glucometer readings because they provide a snapshot of the amount of glucose in the blood over the past two to three months.

    Currently, an A1C level of 6.5 percent or higher indicates diabetes.6 This is lower than the value used in the past, and it’s likely to be reduced again in a few years, according to Dr. Hom. The rationale for adjusting the numbers is early intervention and better treatment outcomes

    “That’s going to increase the number of patients with diabetes that you’re seeing,” he said.

    Next: Contact lenses and diabetes


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Optometry Times A/V