Managing Patients with Diabetes – The Critical Role of Optometry

Diabetes Australia’s Senior Social Worker Neeta Oakley and External Relations Lead Linda Karlsson; along with optometrist Jacinta Lok from Specsavers Broadbeach, recently shared insights into patient knowledge gaps, barriers to care, and how eye care professionals can play a vital role in supporting those living with diabetes.

What was most evident was that managing a medical condition like diabetes takes a supportive community, working in unison. As eye care experts, optometrists have deep insights and influence that shouldn’t be underestimated in facilitating the best possible outcomes for patients.

mivision. How much knowledge do you think patients have about the potential impact of diabetes on their eye health?

Jacinta. Most of the time, it’s minimal unless they’ve had some family history or previous diagnosis related to diabetes where ocular complications have occurred. They’re not going to have too much of an idea, especially if their diabetes is well-managed. If it’s not something that’s affecting their vision yet, they may be unaware of possible complications. That’s why it’s so important that we, as optometrists, educate them on why regular eye exams are crucial, even if they feel fine.

Linda. While I knew about diabetes as a medical condition prior to joining Diabetes Australia, I initially didn’t realise its connection to eye health. It’s probably one of those things that once you work in this space, you become aware of all the potential complications.

mivision. What would you say are the key barriers preventing people with diabetes from properly managing their eye health?

Jacinta. There are quite a few barriers. Emotionally, the burden of diabetes can be significant when someone is first diagnosed. There are so many life changes happening. They suddenly have to be more conscious of multiple things and attend many appointments; it can lead to appointment fatigue. The fear of potential vision loss or losing their driver’s licence and independence is also huge.

Financially, they might think an optometry visit automatically means there’s a cost involved, when in reality, many optometrists bulkbill for an eye health check. So cost is a perceived barrier. The KeepSight reminder system from Diabetes Australia is helpful for reducing these barriers by keeping track of when patients with diabetes are due for their next comprehensive eye exam.

Neeta. I agree, the sheer number of health appointments a newly diagnosed patient has to attend can be overwhelming. Having that regular prompt from KeepSight, combined with reminders from their optometrist and diabetes educator, reinforces how important it is to prioritise those eye exams.

The key is continuity of care – seeing the same optometrist each time allows them to really monitor any changes. Patients appreciate that long-term relationship.

Linda. Exactly, the KeepSight program reminds patients where they had their last eye exam so they can continue seeing that same optometrist. And coming from Diabetes Australia, it reassures them there’s a whole community supporting their overall diabetes management, not just eye care.

mivision. Are vision loss and losing independence patients’ biggest concerns about how diabetes could impact them?

Jacinta. Definitely. Fear of vision loss is massive. It has this cascading effect on their whole life – if they can’t drive anymore due to vision issues, that’s a major loss of independence. They may have to rely on others for transportation to all their medical appointments or everyday tasks.

Sometimes they’ve had family members who went through issues like macular oedema requiring injections in the eye, which can be terribly confronting. Needles in general are scary for many, let alone having one going into your eye. The question “Am I going to go blind?” always comes up, and it’s a tricky one to navigate as their optometrist. You want to validate their concerns over risks, while reassuring them that proper management can significantly lower those risks.

Neeta. There’s really a spectrum in how patients perceive and cope with their risk. Some may overestimate it and develop a sense of inevitability about vision loss no matter what they do. Others remain confident in their ability to manage it with their healthcare team’s support.

Open conversations are so important for understanding a patient’s specific fears and current state of mind. We shouldn’t assume they all have the same perspective. Using open-ended questions and taking a transparent, non-judgmental approach helps build that trusting relationship.

mivision. What are some effective strategies optometrists can implement in practice to help address those fears and barriers?

Jacinta. First, simply reminding patients that comprehensive eye exams with an optometrist are often bulkbilled and available at no additional cost to the patient can help reduce financial concerns. Taking the time to educate them about why these regular exams are so vital is key. I find using visuals like the retinal images generated by optical coherence tomography (OCT), which is used as part of a standard eye test at Specsavers, can really illustrate the importance in a tangible way when patients can see issues themselves.

At the same time, it’s crucial to reassure them that complications aren’t an inevitable conclusion. Staying on top of management with their healthcare team can significantly lower those risks, even if they do have some early signs of issues. Having an open, caring discussion style builds rapport.

Neeta. Absolutely. The way we communicate is so important for establishing trust and getting through to patients. Using openended questions that empower them to share their concerns, stressors, and current state of mind is ideal. That allows you to provide transparent, judgment-free counselling tailored to their specific situation and readiness to make lifestyle changes.

For some, if they’re not feeling empowered to take action yet, scare tactics about worstcase scenarios can backfire. Meeting them where they’re at and gently guiding them is more effective.

mivision. Once that relationship and openness is established, what are some ways to encourage patients’ consistent compliance with recommended eye care?

Jacinta. Ongoing education and visuals are important for reinforcing why regular exams are so crucial, even if they aren’t symptomatic. If there are changes happening, I show retinal images comparing their eyes over time, whether better or worse. That tangible evidence can motivate people.

Setting reminders for their next appointment is also wise. And using a caring approach – avoiding judgment if they’ve lapsed and reassuring them that small lapses don’t undo all their hard work is crucial. It’s understandable, especially around holidays and celebrations. The key is not feeling so discouraged that they give up trying altogether. Consistent diabetes management is a lifelong journey, not a short-term fix.

Neeta. Identifying and helping resolve any specific barriers is key too. If cost is an issue, guide them toward options like bulkbilling practices or the government’s subsidised spectacles scheme. For transportation barriers, put them in touch with community transport services that could help. The same applies for any other challenges like difficulty with self-care tasks, eyesight issues at home, etc., as it is easy to refer to a low vision support service.

Making those connections to support services through warm referrals – not just giving them a phone number – is so valuable. We can only provide comprehensive care by looking holistically at every aspect impacting their quality of life.

Linda. The KeepSight program’s friendly reminders and referrals back to the patients’ regular optometrist also help maintain that continuity of care over time. The reminders come from Diabetes Australia and are sent in addition to the regular recalls sent out by the optometrist. The reminders also link back to Diabetes Australia and our range of support services. The reminders serve as one piece of a larger ecosystem of support for people with diabetes.

mivision. There has been a lot of media attention given to weight loss drugs like Ozempic. As we know, drastic swings in blood sugar levels can potentially impact eye health when someone has diabetes or is at risk for it. What advice should an optometrist give patients who raise this?

Jacinta. It’s not an area I feel is directly within my scope of expertise as an optometrist. If a patient raised that with me, I would encourage them to have an in-depth discussion with their general practitioner or diabetes educator. Those providers will have a more holistic understanding of the patient’s overall health profile and can make appropriate recommendations after evaluating all the potential risks and benefits.

Neeta. I agree, redirecting them to their primary care physician is wise. You could suggest they write down any specific questions or concerns they have about the impact on their eyes from rapid weight loss fluctuations. That way they’re prepared to have an informed discussion.

It’s also an opportunity to remind patients to be wary of following weight loss advice from unreliable sources like social media influencers. Emphasise that individual assessment from their trusted healthcare team is really important for their safety.

mivision. More broadly, what other practical advice or strategies would you recommend for optometrists when discussing diabetes management through lifestyle factors?

Jacinta. As optometrists, we’re most qualified to advise on the importance of consistent eye exams, why routine care is so crucial, even if a patient feels fine currently, and strategies for compliance like appointment reminders.

Neeta. From my observations, optometrists can also provide valuable advice related to a patient’s quality of life and functioning. If you notice issues like them struggling to read their glucose monitor, lacking confidence with activities like taking public transport, having falls at home, or other vision-related challenges, that’s a perfect opportunity to intervene.

Don’t assume someone else on their healthcare team will make the appropriate referrals. Optometrists are ideally positioned to connect patients to vision rehabilitation services, low vision aids, mobility training, and other supportive resources that can make a major difference. Just having three or four key referral partners you turn to can significantly improve someone’s independence and daily living.

mivision. Summing up now, why is it so important for optometrists to embrace this role as an active part of the diabetes management team?

Linda. This whole discussion has highlighted how an optometrist appointment is far more than just a routine eye check. It’s an important opportunity to offer reassurance, health advice, and provide an avenue for further connections to other services. The response we’ve had from patients and healthcare providers alike reflects how they deeply value and respect optometrists as core partners on their diabetes journey. You’re a trusted voice.

Neeta. Absolutely. People with diabetes consistently report viewing their optometrist as an integral part of their full diabetes healthcare team, not just an ancillary provider. You have their trust and appreciation. I really encourage all optometrists to lean into that role with confidence.

You are a key member of the primary health team for people with diabetes – vision issues affect a person’s quality of life immensely, so you have a very important role.

Jacinta. Discussions like this allow me to step back and realise all the multifaceted care I was already providing for people with diabetes, even if I wasn’t fully conscious of it before.

Now I can be much more intentional in how I approach those interactions, eliciting patients’ concerns, addressing barriers, making referrals to other providers, and visually showing them the tangible progress we’re making over time.

About KeepSight

KeepSight is Australia’s diabetes eye check reminder program delivered by Diabetes Australia, with the support of Specsavers and the Australian Government. KeepSight reminds people with diabetes when their eye checks are due. Its aim is to eliminate preventable blindness from diabetes through early detection from regular screening.

For more information visit keepsight.org.au.

Neeta Oakley is the senior social worker at Diabetes Australia and a member of the primary diabetes care team that delivers clinical service across Tasmania. She is a subject matter expert on mental health for Diabetes Australia and KeepSight.

She writes extensively for diabetes publications and presents regularly to health practitioners and organisations about how they can support the psychosocial needs of people with diabetes.

Linda Karlsson is the External Relations Lead at Diabetes Australia. She is tasked with exploring ways KeepSight can become part of the optometry sector’s service delivery and support people with diabetes to continue attending regular eye checks.

Ms Karlsson holds a Bachelor’s degree in Equality and Diversity Management and a Master’s degree in Communications for Social Change.

Jacinta Lok is a practising optometrist and the Optometry Director at Specsavers Broadbeach in Queensland.

Since graduating with her Master’s of Optometry from Queensland University of Technology, she has been providing patient-centred eye care and believes treating patients as people, rather than conditions, leads to the best outcomes.