When optometric opportunities present themselves, we ODs are in a privileged situation—we can choose whichever seems most interesting and enjoyable. However, we must carefully weigh our interests with those of our patients. What opportunities will best serve our patient populations? Certainly myopia progression, dry eye disease and cataract surgery comanagement are on the rise in just about every practice. Other areas of growth, highlighted in this month’s issue, include age-related macular degeneration (AMD) and diabetes management. 

Ask the Right Questions

The first step to taking advantage of the opportunities is deciding which subspecialties would be ideal for you, your practice and your patients. This, of course, requires asking the right questions:

  1. Is it a significant population? 
  2. Can I make a difference in the patients’ lives (i.e., is it treatable/manageable)?
  3. Are there diagnostic technologies that can readily identify and monitor these patients?
  4. Does it have a reasonable chance of benefiting my practice?
  5. Does it positively impact the patient?

Let’s answer some of these questions for this month’s topics.


The number one cause of blindness in Caucasian patients, AMD accounts for more than 50% of all blindness.1 Without a doubt, it’s a significant and growing population. Although not considered curable, it is more manageable than ever before with nutritional supplementation, protection from ultraviolet and high-energy visible light and anti-vascular endothelial growth factor injections.2 

New diagnostic technologies such as dark adaptation and OCT imaging, including OCT angiography for wet AMD, assist in accurate diagnosis and management. For example, making an early diagnosis, such as stage 1 or even sooner, with the help of a failed dark adaptation test allows you to recommend a carotenoid supplement as soon as possible to help slow progression as much as possible and preserve the patient’s vision. 

These technologies carry CPT codes and also help dictate the proper follow-up—ensuring a positive impact on your practice. Obviously, AMD comes with a significant emotional component, and establishing an early diagnosis with proper management provides patients hope and trust in you as a physician. 

Diabetic Retinopathy

Few systemic conditions have ocular manifestations even remotely close to diabetes, and optometrists can play an enormous role in helping patients better manage the condition. The disease affects more than 20% of all Hispanics and more than 16% of African Americans, and that’s just the minority populations in most practices.3 

We should involve ourselves in systemic disease assessment by asking patients about their A1c, cholesterol, blood pressure and smoking status—all of which contribute to diabetes progression. Simply questioning the patient often raises their awareness of these cofounding issues and helps them make healthier lifestlye choices. 

Diabetes may affect the entire body, but the eyes are one of the key organs that manifest findings crucial for diagnosis and management. Dry eye affects more than 50% of patients with diabetes, and diabetic retinopathy is the leading cause of vision loss in working-age adults.4,5 All of this means we are integral to the care team for this enormous and rapidly growing patient population. 


Opportunity is knocking… be sure you are well prepared to answer the door.

Note: Dr. Karpecki consults for companies with products and services relevant to this topic.

1. Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122(4):477-85.

2. Chew EY, Clemons T, SanGiovanni JP,  et al. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 Report Number 1). Ophthalmology. 2012;119(11):2282-89.

3. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care. 2009;32(2):287-94.

4. Zhang X, Zhao L, Deng S, et al. Dry eye syndrome in patients with diabetes mellitus: prevalence, etiology, and clinical characteristics. J Ophthalmol. 2016;2016:8201053.

5. National Eye Institute. Facts About Diabetic Eye Disease. https://nei.nih.gov/health/diabetic/retinopathy. Accessed May 9, 2019.