In this issue:
Last year, the Centers for Disease Control and Prevention announced some alarming statistics: diabetes in the United States affects more than 29 million people, or one in 10; of those, 8.1 million are undiagnosed; 86 million people have prediabetes; and diabetes remains the seventh leading cause of death. Additionally, the National Eye Institute estimated that 7.7 million people age 40 and older have diabetic retinopathy, and by 2030, that number is expected to increase to approximately 11 million people. These statistics are grim. However, there is one statistic that can be taken in a positive light—95 percent of severe vision loss and blindness from diabetes can be prevented. With early detection, timely treatment, and appropriate follow-up care, people can protect their sight.
People with diabetes have a lot to consider when thinking about their health and controlling their disease. Sometimes vision health may get lost in the shuffle, especially due to the asymptomatic nature of diabetic eye disease. Diabetic eye disease isn’t just one disease, but a group of eye problems that includes cataract, diabetic retinopathy, and glaucoma. There are often no symptoms in its early stages, so a person might not even know he or she has an eye disease until it has progressed and noticeable vision loss occurred. It’s important for people with diabetes to have comprehensive dilated eye exams at least once a year to detect eye disease early, when it’s most treatable. Although there have been great advances in how diabetic retinopathy is treated, vision loss from diabetic eye disease often can’t be restored, making the need for early intervention even more important.
Whether you’re a health professional or a community educator, or you care for someone with diabetes, we invite you to join the National Eye Health Education Program (NEHEP) this November during National Diabetes Month in raising awareness about diabetic eye disease. NEHEP offers a variety of English and Spanish resources that you can use to inform people about how they can protect their sight. Visit our National Diabetes Month resources page to find our social media toolkit, which includes ready-to-use posts for Facebook and Twitter; infographics; infocards; videos; drop-in articles for your newsletters, blogs, or websites; teaching tools; and more. We’re especially excited to highlight our new TRACK infographic in both static and animated formats. This infographic relays the important message that in addition to annual dilated eye exams, people with diabetes need to Take their medications as prescribed by their doctor; Reach and maintain a healthy weight; Add more physical activity to their daily routine; Control their ABC’s—A1C, blood pressure, and cholesterol levels; and Kick the smoking habit. These behaviors can help delay the onset or slow the progression of diabetic eye disease.
Please help us share these important messages via your social media pages, posting it on your website, featuring it in your blog or newsletter, or printing it out and using it as a handout or poster during National Diabetes Month or anytime throughout the year.
NEHEP also has several exciting projects underway. We are busy planning activities for Glaucoma Awareness Month in January and Low Vision Awareness Month in February and getting ready to pilot test a new program about eye health that targets African Americans. We are also completely redesigning the NEHEP website and plan to launch it in late spring. Stay tuned!
As always, we invite you to share with us what you are doing to raise awareness about eye health in your own community. Elevating vision health as a priority for Americans takes collaboration, idea and resource sharing, and year-round outreach efforts. Send us an email, post to our Facebook page, or submit an article for the next issue of Outlook to share your activities with NEHEP Partnership organizations and others interested in eye health education.
It’s All About ME―What To Know About Macular Edema
By Suber S. Huang, M.D., M.B.A.
Chair, National Eye Health Education Program
“You’ve got the macular? I’ve got some, but my sister…she’s got all kinds!” Despite the word retina becoming more commonplace, the macula and its diseases are often feared and misunderstood. The retina is made up of light-sensitive layers of cells that line the inside of the eye. These many layers work together to convert what we see into an exquisitely coded signal that travels to the brain. There, the message is decoded and directs us to take action―“That’s a fine-looking piece of pie!”
The macula is the part of the retina that helps us see fine detail, far away objects, and color. It’s packed with more photoreceptors than any TV or monitor, which is why it is prized real estate. It is the small, central area of the retina that’s worth the most―the bull’s-eye of sight. When things happen to the macula, the word gets an “r” at the end. Macular edema; macular degeneration; macular hole, pucker, drusen, scar, fibrosis, hemorrhage, and vitreomacular traction are common conditions that involve the macula. Common symptoms include distorted vision (metamorphopsia), blank spots (scotoma), and blurred vision.
Macular edema refers to an abnormal accumulation of fluid in the layers of the macula. From the side, it looks like the snake that ate the pig. Like a droplet of water on your computer screen, images are distorted by the swollen retina, making it more difficult to see clearly. The more widespread, thicker, and severe the swelling becomes, the more likely one will notice visual symptoms. If untreated, chronic macular edema can lead to irreversible damage to the macula and permanent vision loss.
The most effective treatment strategies address the underlying cause (diabetes, blood vessel occlusion, neovascularization, inflammation, etc.), as well as the hyperpermeability of the capillaries in and around the macula. Eye drops, laser, placement of long-acting medication implants, and surgery are effective in many diseases, but the mainstay of treatment is now intravitreal injections (IVI). IVI is an office procedure painlessly performed under topical anesthesia in which medication is placed inside the eye by a very small needle. IVI should be performed by a trained retina specialist, with meticulous monitoring of treatment efficacy and of extremely rare but potentially serious complications. Still, IVI is considered one of the most commonly performed procedures in the world.
There are FDA-approved medications that treat the common conditions causing macular edema. The most common ones are Lucentis, Eyelea, and Ozurdex. Avastin is not FDA approved but has been extensively studied in large, well-designed, federally funded clinical trials and is considered to be a good option. Each medication has a considerable track record of success and works by decreasing the amount of fluid leaking from abnormal blood vessels.
There has never been a more successful time in the treatment of macular edema and macular disease. While much has been discovered, many promising therapies await.
To learn more about macular edema, visit the NEI Macular Edema page.
November is National Diabetes Month, a perfect opportunity to raise awareness about the need for people with diabetes to control their disease and prevent the onset or slow the progression of vision complications.
Diabetic eye disease is a complication of diabetes that includes cataract, diabetic retinopathy, and glaucoma, all of which can lead to vision loss or blindness when left untreated. There are often no symptoms in the early stages of diabetic eye disease, but it can be detected before noticeable vision loss occurs. Even more important to note is that 95 percent of severe vision loss from diabetes can be prevented through early detection, timely treatment, and appropriate follow-up.
The National Eye Health Education Program (NEHEP) has a variety of materials in English and Spanish to help you share prevention information with people who have diabetes in your community; with partnering organizations or networks; and with family, friends, and colleagues. The following are just a few resources and ideas about how to use them. You can find these as well as additional resources, like drop-in articles, photo novellas, public service announcements, and more, on the NEHEP National Diabetes Month resource page.
TRACK Infographic and Animation
Add the TRACK message infographic or animation to your social media pages, an article, your newsletter, or your website to provide at-a-glance information on how people with diabetes can keep their health on TRACK.
- Take your medications as prescribed by your doctor.
- Reach and maintain a healthy weight.
- Add more physical activity to your daily routine.
- Control your ABC’s—A1C, blood pressure, and cholesterol levels.
- Kick the smoking habit.
Diabetic Eye Disease Infographics
Share an infographic on diabetic eye disease or diabetic retinopathy. These infographics provide at-a-glance information on diabetic eye disease, prevalence rates, risk factors, and how people can protect their vision if they have diabetes. You can link to these infographics from your social media outlets or add them to an article, story, newsletter, or website.
Diabetic Eye Disease Infocards
Use our diabetic eye disease infocards to share short and simple facts about diabetic eye disease on your social media outlets, websites, and newsletters. Pair the infocards with action-oriented social media posts to encourage likes, comments, and sharing.
Diabetic Eye Disease Social Media Resources
Visit our Pinterest board on diabetic eye disease to find a variety of resources from NEHEP and its partners that you can share. Use our social media toolkit and ready-to-post Facebook and Twitter messages that you can copy and share on your pages. Visit our YouTube channel to find videos that show how a comprehensive dilated eye exam detects diabetic retinopathy, how a community health worker uses the NEHEP Diabetes and Healthy Eyes Toolkit, or what people with diabetes know about their eyes.
Tip Sheets for Health and Community Professionals
Download the following tip sheets to find information and tips to teach special populations about diabetic eye disease and to learn what you can do to help them prevent vision loss and blindness: Educating African Americans About Diabetic Eye Disease, Educating Older Adults About Diabetic Eye Disease, Educating American Indians/Alaska Natives About Diabetic Eye Disease, and Educating Hispanics/Latinos About Diabetic Eye Disease.
Diabetes and Healthy Eyes Toolkit and Online Training Course
Use the Diabetes and Healthy Eyes Toolkit to address diabetic eye disease in diabetes self-management classes or community workshops. An online tutorial will guide you step-by-step on how to use the toolkit and all of its components. Everything you need to know about diabetic eye disease and how to conduct an educational session is in the tutorial, including interactive features like knowledge checks and downloadable materials.
These are just a few resources NEHEP offers. For more resources and ideas for raising awareness about diabetic eye disease in your community, visit https://www.nei.nih.gov/nehep/NDM.
The National Eye Health Education Program (NEHEP) is excited to welcome two new organizations to the NEHEP Partnership—The Hadley School for the Blind and Women’s Eye Health.
The Hadley School for the Blind is a nonprofit organization that provides distance education programs and services to individuals with vision loss. Its five main program areas are (1) Low Vision Focus @ Hadley, (2) Hadley School for Professional Studies, (3) Family Education, (4) Adult Continuing Education, and (5) High School. Hadley supports each of its program areas through traditional coursework, live and archived webinars, and instructional videos. Most programs are provided at no cost and can be accessed from a person’s home. Hadley also offers a number of brochures, flyers, and other collateral materials, available in information packets and at conferences and workshops, including a new brochure on the Low Vision Focus @ Hadley program.
To learn more about the Hadley School for the Blind and to find ways to promote independent living for people who are blind or visually impaired, visit http://www.hadley.edu.
Women’s Eye Health (WEH), a 100-percent volunteer organization, was formed in 2001 by a group of researchers from Massachusetts Eye and Ear/Schepens Eye Research Institute of Boston and colleagues from around the world in response to the fact that two thirds of the world’s population of blind and visually impaired persons are women. Its current sponsors are Harvard Medical School Department of Ophthalmology and the Allergan Foundation. WEH’s executive committee, advisory board, and chapters span both national and international organizations. The organization strives to alert and educate women and their families at the grassroots level with the goal of empowering people to make lifestyle changes that will improve their eye health.
WEH has a strong social media presence, with a Facebook page, a YouTube channel, and a Twitter feed. It participates in many NEHEP TweetChats and shares content from its website and from national organizations, such as Prevent Blindness, the American Academy of Ophthalmology, and NEHEP.
For more information on WEH, visit http://www.womenseyehealth.org.
NEHEP is looking forward to working closely with these organizations to bring important eye health information to those who need it. To learn more about the NEHEP Partnership and find a directory of organizations, visit http://www.nei.nih.gov/nehep/about/partnership.
During National Diabetes Month, the National Diabetes Education Program (NDEP) will promote messages and resources that bring attention to the importance of diabetes education and support to help improve diabetes care and health outcomes.
Diabetes Education and Support. Everyone Has a Role: What’s Yours? is a theme that aligns well with the purpose and work of the National Eye Health Education Program (NEHEP) and its partners, who are working on the frontlines to increase awareness about diabetic eye disease.
Diabetes education is needed throughout a person’s lifetime, not just at diagnosis. There is a lot to learn about diabetes, including what a person with diabetes needs to do to stay healthy and to prevent diabetes-related health problems, such as vision loss or blindness.
NEHEP partners and other community organizations play a critical role in diabetes education and support, particularly in their efforts to urge people with diabetes to have a comprehensive dilated eye exam at least once a year. Diabetes education and support can make a difference in the lives of people with diabetes.
This November, NDEP invites NEHEP and its partners to get involved by visiting http://www.YourDiabetesInfo.org/DiabetesMonth2015.
If you are a person with diabetes, a family member or caregiver, a healthcare professional, or an active part of your community, you play an important role in providing education and support for people with diabetes. Thank you for the role you play!
Communicating effectively across cultures is important for public health professionals. People’s ideas about health and illness can vary by cultural group and sub-group and can affect which health literacy skills are considered culturally necessary. When communicating with diverse cultural groups, public health professionals should be aware of and adjust for linguistic differences, beliefs, values, customs, and behaviors that can affect how the audience receives your intended message.
Here are some tips to make sure you and your materials are well understood:
- Don’t treat culture as something negative or as a barrier that must be overcome. Your cultural background may not be the same as your audience’s, but you can learn about and adjust for language, beliefs, and customs as you would for other factors, such as age or gender, which might affect how the audience interprets the messages.
- Address cultural differences if your messages aren’t in the audience’s preferred language. Consider if interpretation of oral information, translation of written materials, or a complete redesign.
- Adapt messages and materials for the literacy and numeracy skills people have in their preferred language.
- Refer to the National Culturally and Linguistically Appropriate Services Standards as you plan your communication strategy.
To read more about the role of culture in health literacy, please visit http://www.cdc.gov/healthliteracy/culture.html.
Decorative contact lenses remain a popular addition to costumes. To prevent potentially blinding eye infections, the American Academy of Ophthalmology (AAO) is warning the public about costume contact lenses purchased without a prescription. The illegal sale of decorative lenses not approved by the U.S. Food and Drug Administration (FDA) continues despite federal laws, putting many people at risk for sight-threatening complications, such as corneal ulcers and bacterial keratitis.
Stories that illustrate the dangers of costume contacts can help educate the public about the risks. Here are three patient stories from AAO’s EyeSmart website that you can share on social media:
- Boy blinded by costume contact lenses: Costume contact lenses from a gas station cost Julian Hamlin vision in one eye. After 10 surgeries, he still can’t see.
- Scarred for life: Laura Butler wore costume contact lenses for just 10 hours before a severe eye infection scarred her cornea, permanently impairing her vision.
- One night, lost sight: After wearing colored contacts for just one night, Robyn Rouse developed an eye infection requiring a corneal transplant.
Below are AAO’s guidelines for costume contact lenses safety:
- Buy decorative contact lenses only from an eye care professional, such as an ophthalmologist, optometrist, or retailer who requires a prescription and sells FDA-approved products.
- Obtain a valid prescription and eye exam from an ophthalmologist or optometrist if you don’t already have a contact lens prescription.
- Do not fall victim to false advertising claims and lenses labeled as “one size fits all” or “no need to see an eye specialist.” Even for those with perfect vision, an eye exam and prescription are mandatory in order to fit the right size contacts.
- Follow the directions for cleaning, disinfecting, and wearing lenses to avoid eye infections.
- Never share contact lenses with another person or wear expired lenses.
- Remove your contact lenses and seek immediate medical attention from an ophthalmologist if you notice redness, swelling, excessive discharge, pain, or discomfort from wearing lenses. Eye infections such as keratitis can quickly become serious and cause blindness if left untreated.
AAO’s EyeSmart program offers additional resources for eye care professionals and patients, including:
- Losing Sight: Julian’s Story (video)
- “Contact Lenses: No Prescription, No Way” and other public service announcement videos
- Proper Care of Contact Lenses
For more information, visit http://www.geteyesmart.org.
The American Foundation for the Blind (AFB) has new apps available that provide resources to children and adults who are blind or visually impaired.
AFB’s VisionConnect™ app is an accessible, searchable directory of services and training available in the United States and Canada for children and adults who are blind or visually impaired. You can find services such as computer and technology training, daily living skills training, Braille and reading instruction, guide dog training, employment services, and low vision services. The iOS-based app is designed for doctors and their patients, and provides links to resources and tips for living independently with vision loss, including information on products, technology, and employment. Users can also have home survey checklists and medication management tips emailed to them. To download this free app, visit the Apple App Store or http://www.afb.org/apps. For more information, please contact Pris Rogers, VisionAware program manager, at firstname.lastname@example.org.
AFB’s CareerConnect® Web program has launched a free, online, self-paced course for people who are blind or visually impaired. The course is modeled after the Job Seeker’s Toolkit but is specific to maintaining and advancing employment. If you are a professional, log in and generate your teacher code to provide this course to your students; it will allow you to receive copies of their assignments and track their progress. For more information, please contact Joe Strechay, CareerConnect program manager, at email@example.com.
AccessWorld®, AFB’s popular online magazine dedicated to technology and people with vision loss, is available on the go via the AccessWorld app. And now, its newly improved AccessWorld Version 2.0 has been rewritten from the ground up to be much more responsive and includes the following features:
- Automatic updates on new issue launch
- Ability to search the full AccessWorld archive
- Enhanced table of contents, with author information for each article
- Improved article sharing through email and social media
- Full interface refresh, including text resizing through pinch to zoom and toolbar controls
- iPad support
According to the National Eye Institute, the number of Americans with low vision will continue to grow dramatically, from its current rate of 2.9 million to 5 million in 2030 and 8.9 million in 2050. In response, The Hadley School for the Blind, the largest provider of distance education for people who are blind or visually impaired worldwide, has launched a series of 10 free audio recordings designed to help those living with low vision maintain their independence. The recordings share practical ways to address daily living skills made difficult by vision loss.
The recordings are available on CD, on National Library Service (NLS) cartridge, and as free mp3 audio downloads from the Low Vision Focus (LVF) website. Individuals must register online to receive access to the free audio recordings or call 1–855–830–5355 for CDs or NLS cartridges. Each recording is approximately 30 minutes long and covers a different aspect of living independently with low vision. This series helps people move forward using step-by-step tips and techniques, along with information and resources to help maximize the vision they have. The 10 topics are:
- Making the Kitchen User Friendly
- Low Vision Cooking
- Doing Simple Kitchen Tasks
- Basic Tactile Marking
- Simple Home Modifications
- Getting Around the House
- Looking Your Best
- Keeping Prescriptions in Order
- Going Out for a Meal
- Going Out With a Friend
The LVF website provides the latest information about the series. In addition to downloadable recordings, it offers links to free low vision webinars, Hadley distance education courses that are relevant to those with low vision, tips, and resource lists. In the future, Hadley will provide free “quick tip” videos through the website that complement the audio recordings, as well as new monthly webinars.
While the LVF is geared toward older adults, the program is open to any individual who is experiencing sight loss or caring for someone who may be losing his or her vision. Adult children of seniors living with low vision are encouraged to take advantage of the online resources to assist their parents. Caregivers and professionals, especially those working with low vision support groups in local communities, are also encouraged to use the resources available through the LVF website.
For more information or questions, call 1–855–830–5355 or email firstname.lastname@example.org.
The Joint Commission of Allied Health Personnel in Ophthalmology (JCAHPO) brings the premiere event in allied health eye care education to Las Vegas on November 13–16. The 43rd Annual Continuing Education Program will feature more than 200 lecture hours in 23 subject categories, 86 new classes, and more than 80 hours of hands-on workshops.
The conference offers basic workshops on tonometry, retinoscopy, keratometry, refractometry, and equipment repair and maintenance. For more experienced technicians, workshops will be offered on topics such as optical coherence biometry and diagnostic B-scan ophthalmic ultrasound. These workshops provide technicians with the opportunity to practice and diversify their skills in a hands-on classroom environment.
New and returning classes are available in a variety of subjects. Technicians can learn about the effects of blue light on patient vision, brush up on ocular anatomy and physiology, and even learn basic ophthalmology in Spanish.
Four sub-specialty sessions will also be offered. A detailed overview of scribing will be presented, as well as sessions on practice management, retina, and neuro-ophthalmology.
The Association of Technical Personnel in Ophthalmology (ATPO) will conduct certification examination reviews for technicians ready to start their certification process. These courses are designed to assist those who are preparing for their certification examinations. Reviews of the written and practical exams for all three core levels of certification will be offered on Monday, November 16.
The Annual Continuing Education Program also includes two keynote speakers. On Saturday, November 14, ATPO will present Dr. Geoffrey Tabin, professor of ophthalmology and visual sciences, and director of the Division of International Ophthalmology, John A. Moran Eye Center, at University of Utah in Salt Lake City.
Dr. Tabin and Dr. Sanduk Ruit founded the Himalayan Cataract Project (HCP) in 1995. The mission of the HCP is to eradicate preventable and curable blindness through high-quality ophthalmic care, education, and the establishment of a world-class eye care infrastructure. The sutureless cataract surgery, pioneered by Dr. Ruit, makes it possible to bring eye care to remote areas, even if they lack running water or electricity. The HCP has brought their method to the Himalayas and sub-Saharan Africa, where they perform sight-restoring operations and prioritize skills transfer by teaching ophthalmic care at all levels, all over the world.
JCAHPO will also present Rebecca Alexander, author of Not Fade Away, on Sunday, November 15. Alexander is one of only 100 people in the United States with Usher syndrome type III, a genetic disorder that causes progressive hearing and vision loss, generally leading to deaf blindness. Despite this illness and other challenges, Alexander earned a double M.A. from Columbia University in psychology and public health and has her own successful private practice as a psychoanalyst.
For more information, visit www.jcahpo.org/ace2015/.
The National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness and the National Center for Health at the Office of Head Start have collaborated on the new resource, Vision Screening: A Fact Sheet for Early Care and Education Programs. This fact sheet was developed based on NCCVEH’s National Expert Panel recommendations. It was also reviewed by the American Academy of Pediatrics’ Section on Ophthalmology.
This fact sheet provides an overview of common vision problems, suggestions for family engagement, a review of evidence-based screening tools, and guidance on follow-up eye care for referred children from birth to age five. It can be accessed on the Office of Head Start’s Early Childhood Learning and Knowledge Center.
For more information on the fact sheet or general children’s vision topics, please call 1–800–331–2020 or visit http://nationalcenter.preventblindness.org.
The American Academy of Physician Assistants (AAPA) represents more than 81,000 certified physician assistants (PAs) across all medical and surgical specialties and has more than 43,000 members. AAPA represents PAs in all 50 states, the District of Columbia, Guam, and the federal services; ensures their professional growth; and supports their efforts to improve the quality, accessibility, and cost-effectiveness of patient-centered health care, including eye care.
PAs are in a unique position to talk with patients, especially those with diabetes, about their visual health and to make referrals for comprehensive dilated eye exams. Working closely with the National Eye Health Education Program (NEHEP), AAPA has ensured that members are aware of a variety of resources available to them to talk with patients about diabetic eye disease and other eye diseases and conditions.
Recently, AAPA invited the NEHEP director, Neyal Ammary-Risch, to contribute an article to the Clinical Alert section of its journal, PA Professional. In the article, titled “Helping Patients With Diabetes Keep Their Eye Health on TRACK,” she discussed the role PAs can play in educating patients with diabetes about blindness prevention. Additionally, AAPA worked with NEHEP to develop and distribute a fact sheet, Eye Disease Facts for Physician Assistants, which outlines the most common eye diseases and conditions, their symptoms or lack thereof, and who is at higher risk to help PAs identify patients they should talk with about their visual health.
AAPA also includes specific links to NEHEP resources on its website for patient resources, such as the Diabetic Eye Disease: A Self-Guided Module, the diabetic eye disease infographic, and the diabetic eye disease among Hispanics/Latinos infographic in English and Spanish.
AAPA sponsors numerous activities for PAs, including continuing medical education programs. It also engages in research on the PA profession and on health workforce issues in general. AAPA develops policy for the PA profession; advocates on behalf of PAs to Congress; responds to local, state, and national health issues; assists state organizations on legislative and regulatory issues; offers employment assistance services; and sponsors leadership development opportunities. AAPA works jointly with many physician organizations on issues of mutual interest and continues to be one of the most active NEHEP Partnership organizations.
For more information on AAPA, visit https://www.aapa.org.
The National Eye Health Education Program (NEHEP) regularly presents at national meetings across the country. Presentations provide an opportunity to share information and publications, promote NEHEP messages and resources, and strengthen links with partnership and other intermediary organizations. A list of upcoming NEHEP presentations follows. If you plan to attend, please stop by and say, “Hello!”
- Visión y Compromiso 13th Annual Promotor and Community Health Worker Conference
December 10–12, 2015
- Teaching People With Diabetes To Take Care of Their Eyes
- Educating Our Communities About Glaucoma
The National Eye Health Education Program (NEHEP) wants to know what you think about Outlook. Let us know what you find beneficial, ideas for content you would like to see in upcoming issues, or suggestions for improvement. We’re always interested in hearing about your eye health education efforts and especially how you have used NEHEP resources and materials.
Please contact us. We look forward to hearing from you!