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Cuban-American singer Celia Cruz has been dubbed "the queen of salsa music" by her many fans. The queen has been sending a lot more than music over America's airwaves lately.

Ms. Cruz has been sending Hispanics sight-saving messages during the media campaign of Ojo con su Visión (Watch Out for Your Vision), a new outreach program aimed at educating Hispanics about diabetic eye disease. The program is a major Hispanic outreach effort established by the National Eye Health Program (NEHEP) of the National Eye Institute.

Last October, the program went public with a media-campaign kickoff, in which Ms. Cruz is playing a major role. In view of the staggering rate of diabetes in the Hispanic population, Outlook is pleased to report that the media campaign has been a success.

We also want to bring readers news about the next phase of the program, which includes community and grassroots efforts, and to tell readers who would like to participate in the program how to get in touch with NEHEP.

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Salsa singer Celia Cruz and her husband Pedro Knight serve as program spokespersons.

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Since the launch of the media campaign, Ojo con su Visión has reached more than 75 million people with its message about the importance of annual dilated eye examinations for early detection and treatment of diabetic eye disease. "The response we've received has been overwhelmingly positive," said NEHEP Director Rosemary Janiszewski. She noted that the NEHEP has received many requests for more information from the media and from health professionals and the general public.

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The National Eye Health Education Program is coordinated by the National Eye Institute, National Institutes of Health, Public Health Service, U.S. Department of Health and Human Services. This administrative document may be reprinted without permission.

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In a previous issue of Outlook (winter 1995), we informed readers about the high rate of diabetes—and accompanying risk of eye disease—among the nation's Hispanic population. With Hispanics comprising the fastest growing minority group in the country, the NEHEP staff knew that an outreach program for this high-risk population was essential.

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Ophthalmologist Charles Garcia, spokesperson for Ojo con su Vision, puts drops in a patient's eye during the filming of the video news release for the launch of the Hispanic program.

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Using salsa music as a backdrop for the program's message might sound entertaining, but the choice of this venue was based on serious considerations. When NEHEP staff brought together focus groups to find out how best to reach Hispanics, they learned that awareness of diabetic eye disease in this population is remarkably low. They also learned that Hispanics depend on Spanish-language television and radio for much of their information, and that celebrities associated with a given health problem are likely to be influential in raising awareness of that health problem.

That's how Ms. Cruz became involved in Ojo con su Visión. Her husband, bandleader Pedro Knight, has diabetes, putting him at high risk for diabetic eye disease. Because she is popular and well respected in the Hispanic community, and because of her connection with diabetes, Ms. Cruz was chosen as spokesperson for the program. "Her name kept coming up as a credible, respected figure during our planning sessions," said Ms. Janiszewski.

Outlook is published by the National Eye Health Education Program of the National Eye Institute, National Institutes of Health, to provide updates on eye health education and disease prevention activities. Outlook also informs readers of new materials and community activities of the NEHEP Partnership organizations and others interested in eye health education. Contributions are welcome. Please direct all submissions, questions, and comments to: Outlook National Eye Health Education Program 2 020 Vision Place Bethesda, MD 20892-3655 (301) 496-5248

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Filming the Filming
A camera crew films Celia Cruz and Pedro Knight for the Ojo con su Vision PSAs and video news release.

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Ojo con su Visión makes terms like "diabetic retinopathy" easier to understand by using graphics, based on the recommendations of the Ad Hoc Working Group on Hispanic Outreach, the NEHEP's Hispanic community consultants. For example, public service announcements (PSAs) show Ms. Cruz's husband having a dilated eye examination performed by his own ophthalmologist.

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Nielsen Media Research found that, during the first six weeks of the campaign, the program's public service announcements for television reached almost 5 million viewers. The media service that distributed the PSAs reported that Ojo con su Visión represented the highest number of PSAs that it had ever disseminated for a Hispanic media campaign.

"We love the Ojocampaign," said Pablo Sánchez, a producer at the national Hispanic television network Univisión. "The campaign design includes the kind of preventive message that our community needs and directly benefits from," he added.

Radio PSAs reached more than 40.5 million listeners in the same time period, according to Nielsen rating figures. "We started using the Ojo radio PSAs as soon as they arrived, and will air them indefinitely," said Vilma May, PSA director at radio station WUNR in Boston.

The print media campaign also seems to have taken on a life of its own. NEHEP public service announcements and photos were picked up by Spanish-language newspapers throughout the United States and turned into articles. Vanidades, a Hispanic magazine with worldwide distribution, featured the campaign in its January issue. Reporters from Puerto Rican and Mexican publications who had seen the Vanidades article began calling NEHEP for more information so that they could run their own stories about diabetic eye disease.

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Spicy salsa melodies and viewer-friendly media messages are just a couple of the ways that Ojo con su Visión will get the attention of its growing target audience. The second phase of the program will focus on sustaining the message about diabetic eye disease in the community at the grassroots level, which requires a different approach.

The NEHEP staff went back to the information they had compiled during their meetings with Hispanic consultants to determine how to instill ownership of the program in the community itself. Ivette López, leader of the Latino Diabetes Initiative for Action and public health educator at the Centers for Disease Control and Prevention, confirmed that the NEHEP staff was on the right track.

The reason that the NEHEP's plan to sustain the program in the community will work, Ms. López said, is that the NEHEP staff listened to what Hispanics had to say, and then acted on it. "It came from the community, and now it will be put back in the community's hands. They will feel ownership, and they will feel empowered," she said.

Ms. López also thinks that the grassroots phase will be a success because of what she calls the all-encompassing approach the NEHEP staff took. "Because of the way the staff has gone about finding out information—through focus groups—they know how to view the issues in the context of people's lives," she noted.

One of the things that the staff learned from its focus groups and consultants was that the Hispanic population tends to use nonprofit clinics, public health clinics, and emergency departments for its health care. Ojo con su Visión partners distributed resource materials targeting health professionals working in these areas. In addition, resource materials to be used by individual health care practitioners were distributed. Raising awareness among health professionals is an important factor in establishing community ownership of the program, the consultants said.

Families are a cornerstone of every Hispanic culture. The NEHEP published an illustrated booklet called Ojo con su Visión: Si Tiene Diabetes, Lea Esta Historia (Watch Out for Your Vision: If You Have Diabetes, Read This Story). The booklet teaches readers about diabetic eye disease by telling a story. To enhance the grassroots appeal of the story, which centers on friends advising each other about eye examinations, the NEHEP staff placed it in a family context. The reader-friendly text is presented as captions that accompany illustrations of people talking to each other during everyday activities. This type of personal interaction was cited by the NEHEP's Hispanic consultants as an important component of their cultures, and one that was likely to increase compliance.

Ms. López offered advice to the Ojo con su Visión program's community partners, who already have begun taking over responsibility for educating Hispanics about diabetic eye disease, and who will assume even more of the responsibility in the future. "Customize the program to your intended audience. You can't generalize the findings of the focus groups to every Latino group," she said.

Ms. López also noted predictions that the United States could have the largest number of Hispanic people living in any country in the world by the year 2020. "America needs to understand that Latino health is America's health," she said.

With a lot of community involvement and a little bit of salsa music, Ojo con su Visión is bound to change the way our growing Hispanic population cares for its eyes.

For more information about the Ojo con su Visión program, call Rosemary Janiszewski at (301) 496-5248, or write to the National Eye Health Education Program, 2020 Vision Place, Bethesda, MD 20892-3655.

Albert Forbes, O.D., sold his East Los Angeles optometry practice 11 years ago to retire to the seaside farming community of Oxnard, California. He didn't stay retired for long.

Four years ago, Dr. Forbes began providing free vision care for children and senior citizens in a nearby neighborhood with a large Hispanic population through St. Johns Regional Medical Center. He then obtained hospital privileges at the county's medical clinic in Ventura, where he established free eye care clinics for the poor, many of whom are Hispanic. The medical center with which the clinic is associated is a public facility, and provides office space at no cost.

Dr. Forbes now holds free eye screening clinics for people with diabetes, especially those who can't afford regular eye examinations. He has enlisted the services of three retinal specialists and three optometrists, who also provide their services at no cost. The local health department provides Dr. Forbes with a public health nurse, who assists him.

For outreach, Dr. Forbes relies on newspaper articles that feature his activities, public health nurses, physicians, local health care agencies, and, perhaps most important, word-of-mouth "advertising" among his region's Hispanic population.

Dr. Forbes began to recognize the need for the type of service he now offers while he was in private practice. He started his practice, in East Los Angeles, in 1946. Over the years, the Hispanic population in his region burgeoned, from 10 percent when he began his practice to 95 percent by the early 1970s.

As Dr. Forbes examined increasing numbers of Hispanic patients, he noticed that he was beginning to see up to four cases of diabetic eye disease each week. "Diabetic eye disease is so big among this group—it's like an epidemic," he said.

When asked what inspired him to start his one-man campaign to prevent vision loss from diabetic eye disease among Hispanics, Dr. Forbes replied, "It's worth doing. These people are lovely people, and they need the help."

His advice to people who would like to offer services such as his: Approach organizations like the Lions Clubs International. Approach "people who know how to make things happen," he advised.

If anyone can rightly be called an expert in knowing how to make things happen when it comes to preventing vision loss in Hispanics, it's Dr. Albert Forbes.

Albert Forbes, O.D., knows how to make things happen when it comes to prevention of vision loss in Hispanics.

Thanks to the outstanding community spirit of volunteers in the rural town of Alpena, Michigan, residents who have diabetes continue to get the health services they need.

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Ophthalmologist Robert Currier examines a patient for signs of diabetic retinopathy at the Alpena Retinopathy Screening Clinic.

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Between 1986 and 1991, residents of the town had received services at diabetes clinics established by a National Institutes of Health-sponsored research project. When the project ended, so did funding for the clinics. That's when members of the community stepped in and took over. The result is a model program for the early detection of diabetic retinopathy.

The five-year research project was called the Michigan Diabetes Research and Training Center (MDRTC), and was managed by the University of Michigan at Ann Arbor. Among the clinics the project had established was one for retinopathy screening.

A local ophthalmologist, Lions Club members, and employees of Alpena's hospital joined forces to ensure that the clinics continued when the project was over.

"When MDRTC funding ended, the community started working even harder to keep the program going," said ophthalmologist Robert Currier, who belongs to the local Lions Club. Dr. Currier donates his services, equipment, and office space as part of the community effort.

Twice a year, Currier and other volunteers provide residents of Alpena with a free screening clinic. They begin with outreach activities that encourage residents at risk for diabetes and its complications to attend. The volunteers post fliers in physicians' offices, pharmacies, and other locations around town, and place public service announcements on radio and television.

On the days that the screening clinic is held, Dr. Currier's office turns into a health fair. Members of the Alpena Lions Club register participants and guide them through various screening stations.

Nurses screen participants for factors that increase their risk of developing diabetes or its complications. Among the tests performed are those screening for hypertension and high blood cholesterol, low-density lipoprotein, and triglyceride levels. Laboratory fees are paid by local Lions Clubs.

Volunteer podiatrists from Northeastern Michigan's Lakeshore Foot and Ankle Centers examine participants for foot-related complications of diabetes. Certified diabetes educators from the local hospital teach participants about risk factors for diabetic retinopathy and about how to manage their diabetes properly.

"Some of our patients have had diabetes for a long time, and haven't seen a physician in years, let alone an ophthalmologist," Dr. Currier noted. "Some are members of the working poor: people, such as farmers, who may be earning a living but have no health insurance," he added.

After the clinic visit, participants who have abnormal test results are referred for appropriate care. For those who can't afford follow-up care, help is available. The Lions Club offers a Diabetes Assistance Program, and Dr. Currier provides free services to those who can't afford to pay him. The Lions Club volunteers also arrange free transportation for participants who otherwise might not be able to get to their physicians for follow-up care.

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Initially, Alpena was chosen as the site of the research project because of its rural character. "Many of these communities are underserved for diabetic retinopathy examination and education services," said Jan Kane, program director of the Alpena Retinopathy Clinic.

Ms. Kane also is the director of community health at Alpena General Hospital, and is a Lions Club member. Ms. Kane also noted that age was a factor in establishing Alpena as the site of the research project. "The community has many older people, and the incidence of diabetes increases with age," she said.

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Dr. Currier promotes the free services of the twice-yearly clinic through a live radio broadcast.

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One goal of the MDRTC was to help implement recommendations of the National Eye Institute, the Centers for Disease Control and Prevention, and the National Diabetes Advisory Board. The recommendations urged people with diabetes to have routine eye examinations, according to Ronald Hiss, M.D., director of the MDRTC Demonstration and Education Division. "Data showed that, despite a national recommendation with good science behind it, many people with diabetes were not having a simple examination that could save their sight," Dr. Hiss said. The research project was successful in increasing the number of Alpena residents with diabetes who had dilated eye examinations. In 1981, only 34 percent of the residents surveyed had seen an ophthalmologist for any reason; 10 years later, that number had increased to 79 percent.

"The availability of the screening clinic probably contributed greatly to this increase," Ms. Kane said. Because of the efforts of people like Currier and the other volunteers who take part in the screening clinics, that upward trend is likely to stay on course. "This program is beyond politics, beyond health-care reform. It is getting back to the way things were done in communities in this country 20, 30, or 40 years ago," Dr. Currier said.

"This effort is about giving. What we give in terms of volunteer time at the Retinopathy Screening Clinic is very little compared to what we get back," he added.

For more information about the Alpena Retinopathy Screening Clinic, write to Jan Kane, Director of Community Health, Alpena General Hospital, 1501 West Chisholm Street, Alpena, MI 49707-1498, or call Ms. Kane at (517) 356-7337; fax (517) 356-7324. For more information about retinopathy screening clinics in general, see "Screening for Diabetic Retinopathy in Communities," March/April 1992, in The Diabetes Educator.

Outlook checked in with the Lions Club International Foundation (LCIF) to find out how its new education program is coming along. The new endeavor, the Lions Eye Health Program (LEHP), is the LCIF's first education and prevention effort. LCIF recently opened participation in LEHP to Lions Clubs nationwide, after a pilot test in the mid-Atlantic region demonstrated how successful the community-based program could be.

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District of Columbia Lions, in Multiple District 22, led the way to support the Lions Eye Health Program by offering glaucoma screenings for senior citizens in a mobile health unit.

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The Lions pronounce the LEHP acronym as "leap," and that's an appropriate term to describe the program's progress. In addition to the pilot program in Maryland, Delaware, and the District of Columbia, LEHP has expanded participation to 15 more states. On completion of their training, the newcomers to the program joined the ranks of LEHP community educators.

The new program really is a leap for the Lions. In the many years that the Lions have been dedicated to prevention of blindness, they have focused their efforts on treatment of eye diseases and disorders. LEHP is a departure from tradition because it focuses instead on prevention—specifically, prevention of vision loss from glaucoma and diabetic eye disease—through education. LEHP is based on the National Eye Institute's National Eye Health Education Program (NEHEP), and works in partnership with NEHEP. LCIF's SightFirst Program administers LEHP.

The cornerstone of LEHP is that it is community based. Lions Clubs are organized into divisions called multiple districts, which cover large areas made up of many clubs. LEHP provides Lions Clubs in the various multiple districts with packets called Community Outreach Super Kits that comprise just about everything they need to establish a grassroots teaching effort.

In their packets, Lions Clubs members have videos, background information about eye disease, a list of potential program partners, public service announcements, tips on how to work with the media, and more, as part of their training by eye professionals and LEHP leaders. Multiple-district leaders who attend the LEHP training session go on to train representatives from individual clubs, who are more likely to know best how to approach at-risk populations in their own neighborhoods.

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A participant at a vision screening conducted as part of the Lions Eye Health Program receives sight-saving information.

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The staff of SightFirst wisely recognized that the Super Kit couldn't provide one crucial element: a working knowledge of the cultures and customs that form each of the diverse communities that make up America.

"Each multiple district has different things to consider. Given the varied demographics, we allowed each one to develop its own plan of action," Marilyn Merz, the LEHP project coordinator, told Outlook.

Mick Barrus, former international director of Lions Clubs International, is the LEHP chairman for Wyoming, and a good example of why LEHP's community-based strategy works. As the following anecdotes reveal, networking is everything.

Among the Lions Clubs in Wyoming that are taking part in LEHP are three in towns that border a Native American reservation. Members of both the Arapaho and Shoshoni tribes, whose customs differ, live on the reservation. Native Americans have a high incidence of diabetes, which puts them at risk for diabetic retinopathy.

In the past, local Lions Clubs have attempted to interest the tribes in starting their own clubs, without success. However, local ties and friendships seem to be allowing the Lions to establish a foothold on the reservation, enabling them to educate the Native Americans who live on it about eye disease.

For one thing, the LEHP chairman from one of the towns happens to be an optometrist, and he happens to have a friend who works on the reservation. That's one potential point of entry.

Another is Mr. Barrus' knack for tracking grizzly bears. He works for the Forest Service, planning recreation development for the areas around Cody and Yellowstone, where grizzlies roam and sometimes have to be moved to other areas. Coincidentally, a member of the reservation's tribal council also works for the Forest Service, and knows Mr. Barrus. Through Mr. Barrus, the Lions Clubs have appealed to the influential tribal-council member, and have provided him with a 45-minute education session about eye disease.

The network extends even farther, up to Canada. One of the principal actors in the popular film "Dances with Wolves" was Graham Greene, a Native American. His brother, Joe, lives in Canada, where he belongs to a Lions Club. Mr. Barrus has contacted Joe Greene with the hope of enlisting his famous brother as a spokesperson for the Wyoming LEHP program.

The network doesn't stop there. The editor of one of the towns' newspapers is a Lions Club member, as are some of the optometrists who live in the three towns bordering the reservation. They have joined forces to provide educational supplements about diabetic eye disease in the newspaper.

All of these activities are taking place in just one region of Wyoming. Across the state, 40 percent of the Lions Clubs have become LEHP participants so far, and each of them is developing its own network and is planning a program tailored to its unique neighborhood. The same scenario is taking place across the many states that have joined LEHP.

On the other side of the country, Jim Garrett, the North Carolina LEHP project chairman, echoes Mr. Barrus' sense of the importance of personal contact. "Making a presentation at a church or a senior center may be more successful in reaching people than a print or television public service announcement," Mr. Garrett told Outlook. "Grassroots efforts are of the utmost importance," he added.

Ms. Merz, the LEHP project coordinator, agrees. "We're leaving it up to the individual multiple districts as to how they organize," she said. "It's exciting to see what the Lions are doing with the program," Ms. Merz added.

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That doesn't mean that participants don't get plenty of guidance and support from headquarters. Ms. Merz and her colleagues not only provide materials and training for multiple districts, but also review each plan of action before it's launched, and require each multiple district to submit quarterly reports.

LCIF also provides SightFirst grants that help defray the cost of participating in LEHP. If 25 percent or more of the clubs that make up a multiple district sign up to participate, that district is eligible for a grant. In North Carolina, for example, 140 clubs committed themselves to LEHP, exceeding the 25 percent mark that made them eligible.

It's this type of grassroots commitment that's making LEHP a success.

"The Lions, by having a structure at the grassroots level, can really make an impact on the 60 million Americans at risk for diabetic eye disease and glaucoma," NEHEP director Rosemary Janiszewski said.

For more information about LEHP, call Marilyn Merz at (708) 571-5466, or write to Ms. Merz at SightFirst Department, Lions Clubs International Foundation, 300 22nd Street, Oak Brook, IL 60521-8842.

The NEHEP presented Special Recognition Awards to the organizations listed below for supporting the program's goal of preventing vision loss from eye disease. These organizations have been instrumental in helping to reach that goal, and are among the reasons that the NEHEP works at the local level.

All of the American Diabetes Association's affiliates participated in National Diabetes Month activities. Affiliates who received awards for their extra effort include those from the following states:

• Arkansas - The Arkansas affiliate joined eye-care professionals to cosponsor free eye examinations.
• Florida - The Florida affiliate cosponsored 250 eye examinations in one of its regions, and plans to expand this effort to five major regions for this year's National Diabetes Month.
• Georgia - In Savannah, a local ophthalmologist who is an ADA volunteer discussed diabetic eye disease on a television talk show and offered free examinations during the month of November.
• Maryland - The Maryland affiliate cosponsored health fairs and seminars focused on diabetic eye disease, and distributed brochures statewide.
• Ohio - The Ohio affiliate cosponsored diabetic eye disease seminars across the state.
• Oklahoma - The Oklahoma affiliate featured a media campaign, and distributed brochures statewide.
• Pennsylvania - The Pennsylvania affiliate launched a new public awareness campaign called Don't Be Blind to Diabetes, and cosponsored free eye examinations.
• Rhode Island - The Rhode Island affiliate teamed up with local eye professionals to feature a letter-to-the-editor campaign on diabetic eye disease in newspapers statewide.
• Texas - The Texas affiliate cosponsored free eye examinations and distributed educational materials statewide.
• Virginia - The Virginia affiliate joined eye professionals to distribute information about diabetic eye disease through its many existing patient programs.
• West Virginia - The West Virginia affiliate is a little office that made a big effort for National Diabetes Month. The affiliate conducted patient programs on diabetic eye disease, launched a media effort, and distributed information statewide.
• Wisconsin - The Wisconsin affiliate featured a media campaign, and incorporated education on diabetic eye disease in their existing statewide patient programs.

Aurora Regional Medical Center participated in National Diabetes Month activities. The Medical Center sponsored a seminar on diabetes and eye health, and made referrals for people at risk for diabetic eye disease. Brochures were distributed to those who attended the seminar and to patients attending a diabetes education program.

The Bergen County Chapter participated in National Diabetes Month activities. The chapter coordinated activities with local churches, which incorporated messages about diabetic eye disease in their sermons. Brochures and fact sheets also were distributed in church bulletins. Over 1,500 brochures were distributed in churches and libraries.

The Columbus-Lowndes Mississippi Chapter participated in National Diabetes Month activities. The chapter coordinated a screening activity with the Eliza Pillar Nurses Association. Participants were screened for diabetes and high blood pressure. Approximately 2,000 brochures were distributed.

The Detroit Chapter participated in National Diabetes Month activities. The chapter sent diabetic eye disease public service announcements to local newspapers. Brochures were distributed at supermarkets, schools, drug stores, libraries, churches, and other locations in the community. The chapter distributed 12,000 brochures.

InSights, a comprehensive program of The Lighthouse National Center for Vision and Aging, is designed to educate older New Yorkers about the impact of aging on vision. The program also is designed to motivate seniors to maintain their vision health and to learn how to cope with vision loss.

Multiple District 22 served as the pilot project for the Lions Eye Health Program. This program helped to educate people at risk for diabetic eye disease and glaucoma about the importance of dilated eye examinations.

The Magnolia Chapter participated in National Diabetes Month activities. The chapter coordinated activities with local churches and businesses. Over 800 brochures were distributed.

Peninsula Eye Care Center provided funds to develop a television campaign addressing glaucoma and diabetic eye disease. The Salisbury Lions Club cosponsored this activity for the Lions Eye Health Program.

These organizations cosponsored events during National Diabetes Month. Activities included dissemination of information about diabetic retinopathy and use of two virtualreality machines to show individuals how diabetic eye disease affects vision.

The River City Chapter participated in National Diabetes Month activities. The chapter coordinated activities with another Links chapter and with other organizations in the community. Presentations on diabetes were conducted and brochures were distributed.

St. Mary's Regional Medical Center participated in National Diabetes Month activities. Activities included dilated eye examinations, presentations, and distribution of brochures. The medical center coordinated activities with many local organizations, including an American Diabetes Association affiliate and the Boerhringer-Mannheim Corporation.

The Salisbury Lions Clubs established the Lions Eye Health Program (LEHP). Presentations on diabetic eye disease and glaucoma were given at local hospitals, nursing homes, and health departments. The club participated in an eye health TV campaign cosponsored by Peninsula Eye Care Center. The Salisbury Lions Club also promoted LEHP on a local radio talk show.

The San Bernardino chapter participated in National Diabetes Month activities. The chapter sent diabetic eye disease public service announcements to local newspapers and distributed brochures throughout the community.

Working in 23 Ohio counties, POB helps individuals maintain good vision and prevent blindness. POB performs vision screenings at health fairs, shopping malls, senior centers, work sites, and schools. These screenings include visual acuity and glaucoma testing for adults; and amblyopia, color deficiency, and visual acuity testing for children. Children's Right to Sight, developed by POB, is a screening program designed to reach low-income children.

The Tennessee Diabetes Prevention and Control Program participated in National Diabetes Month activities. The department coordinated activities with American Diabetes Association Tennessee affiliates. Activities included promotion of National Diabetes Month in state newsletters; coordination and presentation of a main-entrance table display in a prominent Nashville building; distribution of messages about diabetes on Tennessee state employees' paycheck stubs; a lighted message about eye examinations across the face of a prominent Nashville skyscraper; distribution of brochures and newsletter articles to various organizations, including the Tennessee State Highway Patrol, local Indian Health Services offices, the Tennessee Baptist Convention, and 17 of the largest banks in the state.

WICO Radio invited the Salisbury Lions Club to participate in two radio talk shows. The shows discussed the Lions Eye Health Program and the importance of early detection and treatment of glaucoma and diabetic eye disease.

For the second year in a row, affiliates of the American Diabetes Association (ADA) and the National Eye Health Education Program (NEHEP) Partnership teamed up for National Diabetes Month. The focus of the national event: prevention of vision loss from diabetic eye disease.

Both the ADA affiliates and NEHEP partners presented a spectacular array of unique exhibits across the country. The NEHEP staff were delighted by the level of enthusiasm and creativity that these community participants showed, and appreciate the fact that they went far beyond what they had been asked to do. A few examples follow.

Participants in Baltimore, Maryland, set up a virtual-reality device at a local shopping mall. By simulating vision loss caused by diabetic retinopathy, the device allowed curious shoppers to experience the disease first-hand. Seeing the effects that the disease would have on their vision provided a very real incentive for people with diabetes to have dilated eye examinations in the near future.

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In Nashville, Tennessee, the state health department's Diabetes Prevention and Control Program arranged for windows of a downtown skyscraper to be lit in a pattern that spelled out "Eye Exam Month" each night.

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Curious shoppers who stopped by to see what the exhibit offered also were treated to free photographs of their own retinas. An ophthalmologist from the Retina Institute of Maryland reviewed the photos with shoppers and educated them about diabetic retinopathy and the importance of annual dialated eye examinations.

"Our goal was to raise awareness of the health problems associated with diabetes, while offering participants a chance to learn and have fun," said Judy Goldstein, one of the event's planners.

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If you think part of this sign looks out of focus, you're right. It was one of 235 billboards displayed across Pennsylvania during National Diabetes Month.

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The Pennsylvania ADA affiliate dispatched information statewide. Across the state, 235 billboards carried the message "Blurred Vision Is Just One of the Symptoms" in blurry print that simulated out-of-focus vision. Only the ADA's national toll-free telephone number appeared in normal, easy-to-read print. The Pennsylvania Outdoor Advertisers Association donated the billboard space for the campaign.

The Pennsylvania ADA affiliate also ran public service announcements in the print media and on radio and television. "We wanted to dramatically increase awareness of diabetes in Pennsylvania," said Susan Moore, communications manager for the affiliate.

A dramatic display lit up the night sky for Nashville, Tennessee, residents during National Diabetes Month. The state health department's Diabetes Prevention and Control Program arranged for windows of a downtown skyscraper to be lit in a pattern that spelled out "Eye Exam Month" each night.

Tennessee state employees also found educational inserts in their paycheck envelopes and educational articles in state newsletters. Public service organizations, including police and fire departments and religious institutions, agreed to distribute printed material about diabetic eye disease.

"Our goal is to prevent any more cases of blindness from diabetes in Tennessee," said Yvette Mack, public health educator for the Diabetes Prevention and Control Program.

Florida, which has a high percentage of elderly residents, got right down to business. Older people have a high incidence of diabetes, putting them at risk for retinopathy. The ADA affiliate recruited a team of local ophthalmologists to provide free dilated eye examinations in two regions of the state. Announcements in the print media notified residents of the targeted regions about the availability of the free exams.

Pauline Ellis, vice president of programs for the Florida affiliate, said that attempts will be made to offer the free examinations statewide during the 1996 National Diabetes Month campaign.

The list goes on and on. Suffice it to say that these special events led the National Eye Institute (NEI) to confer the NEHEP Special Recognition Award on 23 participants (the list of award winners is included in this issue of Outlook). All of ADA's affiliates participated in National Diabetes Month by distributing brochures, and are to be commended for their efforts. Those who received awards deserved special recognition for their exemplary commitment.

"We're pleased at what we're seeing in local communities," said Gwen Twillman, manager of community programs for the ADA. "Everyone contributed to National Diabetes Month in some way, but some of our affiliates really went the extra mile. We're very proud of them," she added.

On a national level, the NEI and the ADA launched a National Diabetes Month media campaign that reached 154 million people. It was the community effort, however, that brought the campaign to life. "We relied on the local communities to take the leadership role, and they did," said NEHEP director Rosemary Janiszewski.

The NEI provided 1.2 million information brochures called Don't Lose Sight of Diabetes to agencies at the local level. The brochure listed the toll-free telephone number of the ADA. It also listed the toll-free numbers for the American Academy of Ophthalmology and the American Optometric Association, which provided referrals to eye care professionals.

Across the country, local chapters of The Links, Inc., a member of the NEHEP Partnership, delivered the brochures to churches, local businesses, and other organizations. The Bergen County, New Jersey, chapter of The Links, Inc., contacted ministers and requested that they include a message about diabetic eye disease in their sermons.

The future is likely to hold more community involvement and creative campaigns during National Diabetes Months to come. The ADA and the NEHEP Partnership have agreed to continue to make prevention of diabetic eye disease the theme of the annual event for the next three years. One of the ADA's goals is to ensure that, by 1998, at least 75 percent of Americans with diabetes will be aware that they should have an annual dilated eye examination.

"Working together at both the national and local levels, we can save the sight of millions of Americans," said Ms. Janiszewski.

For information about how your organization can participate in National Diabetes Month, or become involved in diabetic eye disease activities throughout the year, call Rosemary Janiszewski at (301) 496-5248, or write to NEHEP, 2020 Vision Place, Bethesda, MD 20892-3655.

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