- Do you have eye symptoms, such as blurred vision or floaters?
- How long have you had symptoms?
- Who is your doctor?
Note: Diabetes is a multi-system disease, so a multidisciplinary approach is necessary. Each patient may have several care-providers, including an ophthalmologist, nephrologist, endocrinologist, podiatrist, nutritionist, neurologist, and others, not to mention a primary care physician. If patients have other microvascular complications of diabetes, especially renal failure or proteinuria (abnormal levels of protein in the urine- a symptom of damage to the kidney), they have a greater probability of vision-threatening diabetes-related retinopathy. The primary care provider, usually a general practitioner, helps to coordinate care among members of this team. Communication with the primary care provider is an essential component of quality care.
- What is your diabetes-related medical history? (A diabetes-related medical history should include the type and duration of diabetes, past glycemic stability, medications and systemic history.)
Note: There are ways to improve patients’ vision by monitoring their systemic medications. For example, pioglitazone and rosiglitazone have been associated with the development of macular edema, which resolves with cessation of the drugs.
- When were you diagnosed?
Note: The duration of diabetes is a major risk factor for the development of vision-threatening diabetes-related retinopathy. Knowing the length of time since a patient’s diagnosis will aid in predicting the probability and severity of retinopathy.
- In general, how well are you managing your diabetes?
- What was your last hemoglobin A1C?
Note: The most essential modifiable risk factor for the development and progression of vision-threatening diabetes-related retinopathy is glycemic (blood glucose) stability. Severity of hyperglycemia (too high blood glucose) seems to be more important than duration once retinopathy is present. Routinely asking patients about their A1C level will reinforce its importance, and documenting it in the chart at each visit will help track a patient’s progress. It may also be helpful to consider shortening a patient’s follow-up period if his or her disease is poorly managed, as this puts patients at higher risk of vision loss.
- Do you have other health conditions, such as high blood pressure or high cholesterol?
- Do you have any allergies?
- Have you had eye surgery?