Connecting Diabetes and Vision: How Optometrists Can Make a Difference for Hispanic Patients

Early in my career, I saw an elderly patient who made a big impression on me.  This gentleman had come to the clinic for a regular checkup; he was already blind in one eye and only had about 30% of his vision remaining in the “good” eye, due to severe diabetic retinopathy. At the end of the exam, I took a few extra minutes to ask him how it was that he had lost so much vision and discovered that he had a very low level of understanding of the causes or management of diabetes.

We talked a little about his habits and diet. He told me that he had worked for many years as a landscaper and that he would take a liter of soda and some bread with him every day because it was cheap and convenient.  And then, once he retired, he lived alone and didn’t really know how to cook so he still ate a carbohydrate-heavy diet with limited variety.  It made me very sad that he had worked hard all his life, but no one had ever given him basic nutrition information that could have helped him avoid the vision loss that now made his old age so difficult.

Sadly, this patient isn’t all that unusual.  As a Colombian-American myself, I know that our culture is very food-centric, and that many traditional meals are rich in carbohydrates and fried food.  Latinos are almost 2.5 times more likely to develop diabetes compared to non-Hispanic Whites.¹  The majority (68%) of Latinos with diabetes have poorly controlled blood sugar,¹ so it is not surprising that we see rates of diabetic retinopathy and visual impairment that are much higher than among non-Hispanic Whites with diabetes.²

Seeing the stark impact for this patient of a lifetime of poor diet really changed how I practice.  I realized that, even though I’m an optometrist and not a dietician, I need to incorporate some nutrition education into my patient care if I want to holistically address the risk factors for ocular disease and vision loss.  November is Diabetes Awareness Month, so this is a great time to start integrating five simple things that every optometrist can do to reduce the impact of diabetes for our Hispanic patients:

1. Start young

Change is hard once habits have become long-established, so I ask my young adult patients some simple lifestyle questions and I remind them that what they eat and how they use their bodies every day affects their eyes.

2. Provide basic nutrition information

We have limited time for diet and nutrition counseling, but there are wonderful resources available from the American Optometric Association (AOA) that patients can take home with them. I prefer simple, colorful pamphlets that highlight foods that are good for the eyes and that are available in English and Spanish (as well as other languages).

3. Suggest simple swaps

A sedentary older patient isn’t going to suddenly become a health nut who hits the gym every day. But even small changes can help. To keep patients from getting overwhelmed, I encourage them to make just one change they think they can stick with. For example, they could give up soda, swap their usual rice for broccoli or chopped tomatoes with lime, or walk around the block every evening after dinner.  Many patients tell me, “Oh, I don’t like the taste of water,” so I encourage them to add a little lemon and salt to make the flavor more appealing.

4. Emphasize prevention and control 

Many Hispanic patients don’t realize that diabetes can affect their eyes at all.  I let them know that when their blood sugar is poorly controlled, it can lead to vision loss. Vision is the most valued of the five senses, so that awareness is key!  I encourage patients to know their “ABCs” of diabetes (A1C, blood pressure, and cholesterol) and to work with their primary care doctor to get all three under control.  An annual eye exam is also really important for those who are diabetic so that we can detect early changes before there is irreversible vision loss.

5. Communicate clearly

As a bilingual optometrist, I can conduct the entire exam in Spanish.  But even for my colleagues who don't speak Spanish, just learning a greeting in Spanish can help to put patients at ease and change the atmosphere in the room for the better.  When there is a language barrier, speak more slowly and keep your instructions clear and simple.  Provide printed materials about diabetes in Spanish. I also like to give my patients a note in English about their diagnosis, any ocular manifestations or progression, and my recommendations so that they can share with their other doctors or with English-speaking family members. This helps to ensure that the message gets to other medical providers and family caregivers.

With our diabetic patients, it is important to let them know how their eyes are doing at every visit, to reinforce the connection between diabetes and ocular health. I always try to wrap up with a positive message and a reminder that there is a lot they can do to help protect their eyes.

References:

1. Hispanics and Latinos have higher risk for vision loss. Centers for Disease Control.  https://diabetes.org/about-diabetes/statistics/about-diabetes
2. Sprabary A. Eye disease in Latinos: Conditions, risks, and prevention.  All About Vision. https://www.allaboutvision.com/conditions/eye-disease-latino-communities/.

Lina T. Arango, OD, is an optometrist at LTA Vision in Ft. Lauderdale, FL, and a Board Director for Latinos en Optometry. Born in Colombia, she immigrated to the U.S. as a high school student.  Dr. Arango received her optometry degree from Nova Southeastern University in 2009 and completed externships at Shanghai Eye and ENT Hospital in China and at the WJB VA Medical Center in South Carolina. She has participated in several medical mission trips and is the co-founder of Clear Eyes Clear Mind, a non-profit that provides emotional wellbeing and visual health to those in need.

Disclosure: Dr. Arango has no relevant financial relationships to report.

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