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Dear Dr. Gooddoc
Thank you for referring Clare Tesca for an eye exam. As you know she has a history of diabetes mellitus for approximately 6 years that has not been well controlled. She also had symptoms of blurred distance vision and glare at night.
Her exam showed moderate bilateral nuclear cataracts accounting for her symptoms of glare and blurred vision. She performed poorly on glare testing. Because her work requires night driving, it was felt appropriate to refer her to Dr. Stan Stedyhan for evaluation for cataract extraction.
Her exam did not reveal any visible retinopathy on fundus exam or retinal imaging, but there were definitive diabetic changes visible on OCT-A. As you know these changes can be present for 2 years or more before visible retinopathy develops. The patient was shown these changes and was obviously concerned. She then revealed that she is very concerned about losing vision because of an extensive family history of members that have lost vision due to diabetes. She additionally stated that the history is so strong that she feels it is inevitable she will also loose vision and that due to this fear she has been working extra hard to earn income while she still can. In fact she has been emphasizing that over controlling her condition.
It was explained to her that the risk of developing vision threatening eye changes is much higher by not controlling her condition than it is from her family history. After that explanation and showing her clinical outcomes data, she expressed an interest in getting better control of her condition in order to reduce her risk of losing vision in the future.
I have referred her to a diabetic educator as she feels that she needs help in better meal planning and better understanding how to get better control. She stated that you had recommended she see a diabetic educator in the past, but she never actually went on the referral. She has agreed to follow your recommendation so my office scheduled her to see Maka Felgood who will let you know what educational program she recommends to the patient.
Thank you for allowing me to participate in the care of this patient. I have recommended that she return in 6 months to assess any change in her early retinopathy. She understands that we can quantitate the retinal changes and estimate the risk of future changes based on her level of HbA1c control. The patient stated that having the measure will help focus her on getting better control.