Diabetic+Eye+Disease

=**Background on Diabetes in Native Americans**= toc

Many people are aware of the diabetes problem associated with Native Americans, however, very few realize the corresponding eye problems that come with the disease. Before getting into the effects on the eyes, some background about Native Americans and diabetes should be explained. In the past, American Indians typically ate naturally acquired food such as wild game, corn, beans, herbs, nuts, berries, etc. They also were very active with all their hunting, dancing, walking, and the daily physical labor of living outdoors. However, currently their diets consist of meals that are 31-47% fat. (21) Because many reservations have a great amount of poverty, they are living on a low budget supplemented by food stamps. Organic foods are very expensive and require many ingredients to put it together, so these healthy choices are passed over, and cheaper, fatty foods are consumed. This is compounded by the fact that Native Americans typically do not have access to organic grocery stores, just convenience stores, which do not sell the kinds of food that would be better for their health. Foods they commonly eat these days are tortillas, fry bread, friend potatoes, processed meats, desserts, canned foods, and soda. Physical activity is no longer required for survival, so they tend to be more sedentary with activity coming mainly through the channels of pow wows and school based sports. (21) Since two of the biggest causes of diabetes are obesity and physical inactivity, it is clear that these life changes from the traditional ways to the current lifestyle would create a sharp increase in the prevalence of diabetes in reservations. =Effect of Diabetes on Eyes=

Diabetes can affect nearly any part of the eye system, especially the retina, vitreous, lens, and optic nerve (5). Diseases associated with damage in these areas are retinopathy, cataracts, and glaucoma (13). Retinopathy is a cancer in the retina, which is the light sensing area in the back of the eye. A cataract is a clouding of the lens, and glaucoma is damage to the optic nerve. In fact, people with diabetes are twice as likely to develop cataracts, and twenty five times more likely to become blind as the normal population, because the most common cause of blindness is diabetic retinopathy. (6,4). While the numbers don’t look good, these are very treatable diseases as long as the individual has regular eye care and gets one dilated eye exam per year as recommended by the National Eye Institute. (12). =Impact on Native American People=

These problems are heightened among the American Indian population. Not only do they have the highest rate of diabetes in the United States, but they often have eye problems unrelated to diabetes as well. They have been found to have a higher prevalence of visual impairment and normal-tension glaucoma as compared to other groups of people. (1). Astigmatism, which causes vision to be blurred, in children is an increasing problem in some tribes, especially the Tohono O’Odham. (10), while active trachoma is common in southwestern American Indians under the age 20 (16). Trachoma is a disease caused by a bacterial infection, which presents symptoms similar to pink eye, but with reoccurring infections can lead to blindness. It is expected that the diabetes related eye diseases are much more prevalent in Native Americans, since 16.3% of American Indians and Alaska Native (AIAN) adults are diagnosed with diabetes compared to 8.7% of non-Hispanic whites. (6). One of these diseases is retinoblastoma, which is six times more common in Native Americans. (2). =Barriers to Treatment=

There has been difficulty with treating Native Americans in the past because they are often reluctant to accept their diagnosis, and subsequently put little effort into changing their diet and way of life. Also, health professionals experience a language barrier that hampers their ability to help, as well as an understaffing problem (3). Commonly, staff hold their position for a certain number of required years, such as four, and then leave to practice somewhere else. This high turnover creates a void in the continuity of care. However, the largest problem is that tribe members on reservations have a hard time receiving access to health care, due to appropriation of funds by the Indian Health Services (IHS). Less than half of them are able to get the recommended yearly eye exam because they live far from health care centers. (14). Different IHS agencies interpret the federal legislation in their own way, causing varied funding, and an overall lack of regulated guidelines as far as eye care. For example, neither previous cases of low vision, nor non-diabetes related retinal problems are included in funding. Also, astigmatism, amblyopia and refractive errors are often missed in children and are never corrected (4). =Prevention of Symptoms=

There are specific suggestions that are strongly recommended to prevent diabetes or reducing its effect on your body and eyes regardless of ethnicity or race. It is to be expected that these include diet, exercise, and taking prescribed medicines. However, it is also recommended that patients check their blood glucose daily, check feet for cuts or sores, brush and floss teeth daily, and avoid smoking. (8). Some tips are to drink water ten minutes before a meal, walking every day, cooking healthy foods, and setting weight goals. (17). =Progressive Movements=

One of the largest groups working towards national eye care for American Indians is the Indian Health Service, under the Department of Health and Human Services. This organization provides health care to 1.4 million AIAN in 557 tribes, or 70% of federally recognized tribes. (8). They are trying to bring health care to this large group of people to assist with a range of health issues including diabetes management. (11). One project they have been working on is called the Indian Health Service-Joslin Vision Network (IHS-JVN) Teleophthalmology Program. This has been around since 2000 and consists of a specialized camera that is used to take pictures of patients’ eyes. It reflects the light off their eyes in such a way that when these pictures are sent to an eye doctor they can tell their level of retinopathy or other eye diseases and make a recommended course of treatment. (14). This early diagnosis and treatment can decrease vision loss by 95%. (15). Congress has also passed laws that allow AIAN to receive Medicare and Medicaid in their own Indian health facilities, which has increased the number of patients that are able to get health care. (18) Other efforts have been made separate from the government as well. Groups such as the AANAC (Astigmatism and Amblyopia among Native American Children) have done studies to find cost effective methods for early detection of astigmatism and amblyopia, to make them more affordable and widely used in the poverty stricken reservations. (9) Volunteer groups, such as the OneSight Regional Clinic, help by providing free vision care and eyewear to Native American Reservations nearby. (19). Finally, individuals have taken a stand themselves by overstaying their required number of years on reservations in order to guarantee effective vision care. Commander Dawn Kelly has been working in reservations in Arizona for the past twelve years. An example of her impressive efforts is how she provides optometry care to remote tribes for a week at a time every three months. (20). Diabetic eye disease is a large-scale problem in the Native American population. Recognized efforts by health professionals and the diagnosed themselves can exponentially impact the severity of symptoms being experienced.

Works Cited 1. Alvarado, Jorge. "Diabetes and Your Eyesight." Glaucoma Research Foundation, 7 Mar. 2011. Web. 11 Apr. 2011. . This website gave some basic information about diabetes, and then went on to describe how it can cause diabetic retinopathy and cataracts. The final topic was how these eye problems can be prevented. This site is credible because it follows the information released by the National Institute of Health, and it references the National Eye Institute. 2. Bettman, Jerome. "Arch Ophthalmol -- Abstract: Eye Disease Among American Indians of the Southwest: I. Overall Analysis, September 1972, Bettman 88 (3): 263." //Archives of Ophthalmology//. Web. 5 Apr. 2011. . This was another credible source through the Archives of Ophthalmology, however this source described the clinical records of over 1,500 American Indian patients. Information was given about which disease were more and less common among these patients compared to the general population. 3. Bettman, Jerome W. "Eye Disease Among American Indians of the Southwest." Archives of Opthalmology. Web. 5 Apr. 2011. This was a report of a study concerning southwestern American Indians and the active trachoma cases that were noticed in that region. A discussion was given about how their introduced therapy helped a large majority of the cases that were presented. It is through the credible source of the Archives of Ophthalmology. 4. //Bringing Better Health Care to Native Communities//. Tribal Affairs, Mar. 2009. Web. 6 Apr. 2011. . This was a brochure from Medicare regarding the changes Congress had made that affected the Native American people. These changes included receiving Medicare and Medicaid services at local Indian Health facilities. It is credible because it is through the government. 5. "Division of Diabetes Treatment and Prevention (DDTP)." //Indian Health Service//. Web. 6 Apr. 2011. . This website by the IHS told why AIAN have trouble preventing diabetic eye disease due to the lack of national standards. It then went on to describe the technology of the IHS-JVN as a digital camera that captures medically useful picture of the eye. The fact that it is through IHS makes it credible. 6. "Division of Diabetes Treatment and Prevention (DDTP)." Indian Health Service, June 2008. Web. 5 Apr. 2011. . Here I found a list of statistics and facts regarding American Indian Health that was very useful for quick information. IHS also sponsors it. 7. Gille, Meriah. "The Role of Culture in Native American Food Choices and Perceptions OfPhysical Activity." Seven Directions Native American Health Center. Web. . Through this website I found out why diabetes has become such a problem for the Native Americans. There was information about their changes in lifestyle from traditional to contemporary, and facts about their health care. It is sponsored by the Seven Directions Native American Health Center, which is a very reputable program. 8. "IHS Optometry Program - Missions and Goals." Indian Health Service. Web. 11 Apr. 2011. . A description of IHS was given on this page along with their mission and goals. This website shows how the IHS has a hand in a large majority of tribes health care and how wide the scope of their influence really is. Once again, this site is funded through the government, so credible. 9. "Indian Health Diabetes Best Practice Diabetes Eye Care." Indian Health Service, July 2009. Web. 5 Apr. 2011. . Through this website I gained an understanding of how diabetes can affect the eye and the prevalence of these diseases for Native Americans. There are also clinical recommendations for how to create, evaluate, and sustain diabetes eye care programs. This credible website was derived from the IHS government website. 10. "The Indian Health Service- Joslin Vision Network Teleophthalmology Program." Indian Health Service, Mar. 2008. Web. . This was an online brochure giving more information about IHS-JVN and how effective it has been and how it works. Information is given about how it has caused an increase in the number of eye exams that have been given since it is much more cost effective. This is also credible due to its IHS affiliation. 11. Kruse, Diane. //Serving Native American Country with Broadband Services//. Web. 5 Apr. 2011. . This website gave very specific details on how IHS is working to broaden their services and become more centralized. It also goes on to make an argument at the end about how natives on reservations should be the first in line to receive funding. This article is written by a woman who is a CEO, past-CEO, and past chairman, so that makes it seem very credible as she must know this information in order to have held these positions. 12. Mansberger, Steven L. "Causes of Visual Impairment and Common Eye Problems in Northwest American Indians and Alaska Natives." 30 Dec. 2004. Web. 11 Apr. 2011. . This website gave a detailed description of many races and the types of eye problems they typically experience, then went on to describe how this information is not know about Native American populations. It also explained a plan of what should be done to effectively help the most people possible. This site is affiliated with the National Institute of Health. 13. Miller, JM. "Astigmatism and Amblyopia among Native American Children (AANAC): Design and Methods." National Center for Biotechnology Information, Sept. 2000. Web. 11 Apr. 2011. . Here was a site addressing the efforts made by the AANAC to find cost effective astigmatism detection instruments. This paper has a description of the design and method of the study they performed for this purpose. It is a study reported through a government site, so it is credible. 14. "Prevent Diabetes Problems: Keep Your Eyes Healthy." National Diabetes Information Clearinghouse, Nov. 2008. Web. 11 Apr. 2011. . A general description of diabetes and diabetes related eye diseases was given on this site, along with diabetes control and prevention recommendations. It was organized with a frequently asked questions format and seems to be very accessible for anyone who wants to know more about their diabetes condition. This was put up by the National Institute of Health as well. 15. Sherrill, Duane L. "The Stability of Astigmatism in Native American Preschool Children." Journal of Vision, 16 Dec. 2002. Web. 11 Apr. 2011. . This was a study published by the Journal of Vision regarding the reported change in astigmatism in the Tohono O’Odham. This study was done over the course of a year on 179 children of an average age 3.6. The fact that it was published in this well-established journal gives it credibility. 16. Silver, Karen, Meredith Williams, and Everly Macario. //THE NATIONAL EYE HEALTH EDUCATION PROGRAM: INCREASING AWARENESS OF DIABETIC EYE DISEASE AMONG AMERICAN INDIANS AND ALASKA NATIVES//. Ethnicity & Disease, Autumn 2006. Web. 4 Apr. 2011. . Here was reasoning for why American Indians have greater risk for diabetic eye disease. There were a lot of details about a study they did, but I mainly used information found in the introduction about diabetic eye disease, and the discussion at the end about the barriers that hamper health professionals from being effective. This is a strongly credible article released by the National Eye Health Education Program. 17. //Ten Ways American Indians Can Prevent Type 2 Diabetes//. National Diabetes Education Program, Apr. 2008. Web. 5 Apr. 2011. This site simply gave a list of ten tips towards Native Americans for them to prevent and control diabetes and its symptoms. The ten tips included making lifestyle changes of a better diet and working out more, along with losing ten pounds and keeping an eye on diabetes symptoms. This site is credible because it is through IHS. 18. Topor, Irene L. "Indian Health Services: Creating a Balance Between Federal Legislation and the Vision Care Needs of Sovereign Nations - JVIB - Special Supplement." //American Foundation for the Blind - Home Page//. 2009. Web. 11 Apr. 2011. <http://www.afb.org/jvib/jvib001315.asp>. Here was an in depth website regarding what the IHS is doing, and how they are falling short regarding the GPRA indicators that include eye care. It also gave recommendations for how all professionals in the eye industry should respond to overcome this need. Since this was published by the American Foundation for the Blind, it seems very credible. 19. "Volunteers Make Difference at Native American Reservations." OneSight. Web. 5 Apr. 2011. <http://www.onesight.org/na/news/volunteers_make_difference_at_native_american_reservations/1879>. This site gave the example of the OneSight giving out free eye exams and eyewear in Walking Shield, CA. It was not very in depth, but the fact that it was made by the actual organization seems reliable. 20. Will, Chavez. "Cherokee Improves Eye Care on Reservations." Cherokee Phoenix, 23 Jan. 2007. Web. 6 Apr. 2011. This was an article including many quotes by Commander Dawn Kelly, who is also a Cherokee member, about her work in Cherokee reservations of Arizona. The article also details her day to day responsibilities and some of the specific cases she has worked with. It is credible because it is a government sponsored website.