Webinar: Using the Diabetes & Healthy Eyes Toolkit in Indian Country

Good afternoon, everyone. The Indian Health Service
Community Health Representative Program is very pleased to
welcome you to today’s webinar, Learning to Use the Diabetes
and Healthy Eyes Toolkit: New Educational Resources
for Indian Country. My name is Cathy Stueckemann,
and I’m the director of the Community Health
Representative Program. IHS is excited to bring you this
interactive training webinar, in conjunction with the National Eye Health Education Program of the National Eye Institute at the National
Institutes of Health. I’d like to now introduce
our guest speakers for today. Joining us from the National
Eye Health Education Program, called NEHEP, is
Neyal Ammary-Risch, the director of NEHEP. Neyal manages the planning,
development, implementation, and evaluation of national
health education programs on diabetic eye disease,
glaucoma, age-related eye diseases and conditions,
low vision, and community and special population outreach. She also serves as the NEI
health literacy coordinator and oversees social media for NEHEP. Thank you, Cathy. And thank you to everyone
who registered for the webinar today and for ordering your
materials in advance and logging in to participate. It’s really an honor
to be with you today and to support the
critical work that you’re carrying out
in your communities. Thanks, Neyal. Also joining us is Marcela
Aguilar, a senior public health manager with almost 20 years of
experience leading communication and social marketing efforts. Marcela has specialized in
developing and facilitating training workshops for
health professionals and other adult learners in
issues as varied as eye health, reproductive health,
HIV/AIDS, school safety, veterans’ health,
and adolescent health. She currently supports NEHEP
in reaching populations at higher risk for eye
diseases and conditions. Thank you, Cathy. And thanks to everyone for
joining today’s webinar. I’ll turn it now over to
Neyal to get us started. Thanks again, Cathy. And good afternoon, everyone. Today’s webinar was developed
to equip you with resources so that you can deliver eye health
education in your community, specifically using our Diabetes
and Healthy Eyes Toolkit. We’ll be covering quite
a bit of information during this training webinar. We’ll start by
discussing diabetes and the parts of the eye. Next, we’ll talk about how
diabetes affects the eyes. We’ll then take an
in-depth look at the Diabetes and Healthy
Eyes Toolkit. And finally, we’ll review
some other educational resources that NEHEP has
available to help you in your education and
outreach efforts. As Cathy mentioned, during
this webinar you’ll have opportunities to engage
with the content and with the presenters through
polls and chats. There will also be
time at the end so that you can ask us some questions. In order to make sure
we’re all on the same page, I want to just quickly
cover a few important facts related to diabetes. First, what is diabetes? Many of you already know that
diabetes is a very serious disease in which
glucose or sugar levels in the blood are high. It can cause problems such
as blindness, heart disease, kidney failure,
and even amputation. Diabetes
disproportionately affects American Indians
and Alaska Natives. The latest data from
the U.S. Department of Health and Human Services’
Office of Minority Health and the American Diabetes
Association shows that American Indian and Alaska Native adults are over twice as likely as white adults to be diagnosed with diabetes. Diabetes is least common among
Alaska Natives, with about 5.5 percent adults being
diagnosed, and most common among American Indians in the
Southern Arizona area, with 33.5 percent folks
being diagnosed. Approximately 30 percent
of American Indians and Alaska Natives
have prediabetes. This is a critical situation
that’s being addressed in research, clinical programs,
and community and education outreach efforts, such as
those that you all carry out. So, now it’s your turn. Please share with us in the
group if you’re currently providing diabetes education. You can use your mouse to
select an answer on your computer screen, and
either click “yes” or “no” and then hit submit. Okay; great. It looks like a majority
of you are already doing diabetes education. And those who are not, we’re
hoping that what you learn today will help increase your
awareness about eye health and the complications of it,
and address eye health in the diabetes outreach that
you’ll start to do. So, one more
question for you. For those who are doing
diabetes outreach, do you do eye health as part of the
information you provide? So, again, click on “yes”
or “no” and then click submit. Okay. Results are still coming in, but
it looks like for those of you doing diabetes education,
not everyone is addressing the eye complications. So, we’re really hoping
that you’ll learn a lot about diabetic eye disease today and
then what you can do to include diabetic eye disease awareness
as part of what you’re doing with your patients and
those in your community. So, one more question we would
like to know here from you is to know what are some typical
questions you usually get about the effects of
diabetes on vision? So, you can type your answers
in the chat box in your screen. And I’ll give you a couple
seconds to think about that. Okay. So, some of the
questions that we see. How can diabetes
affect vision? Will I go blind if
I have diabetes? How soon will I go blind? What is retinopathy? If I have lost vision to
diabetes, can I regain it? What can I do to
prevent losing vision? What are the symptoms of
diabetes in the eyes? How does diabetes
affect vision? Why do I have to get my
eyes checked every year? Okay. And some people said they
haven’t had questions about it. So, there’s a lot of
questions that people ask, and we’re going to address all of
these throughout this webinar. And if you do have other
questions you want to share, please continue to share
them through the chat box. So, I want to go over
a little bit about how diabetes affects vision. But first, it’s important
that we learn a little bit more about the eye itself. The eyes, although they’re
small, are very complex organs. And since we only have an hour
together, we’re going to focus on just three key
parts of the eye: the retina, the optic
nerve, and the lens. And you can see each of these
highlighted on your screen. So, let’s start
with the retina. The retina is the
light-sensitive tissue at the back of the eye. It converts light into
electrical impulses that are sent to the brain
through the optic nerve. A healthy retina is
necessary for good vision. Now, let’s move on
to the optic nerve. The optic nerve is a
bundle of more than one million nerve fibers that
carry visual messages from your retina to your brain. And then finally, let’s
take a closer look at the lens. The lens is the clear part of
the eye behind the iris that helps to focus light
or an image on the retina. The lens is made up mostly
of protein and water. So, as we know, diabetes
can affect many parts of the body and
especially the eye. When we talk about the eye
problems that people with diabetes face, we use the
term diabetic eye disease. However, diabetic eye
disease is not a single disease. It actually includes these
diseases and conditions: diabetic retinopathy,
cataract, and glaucoma. Unfortunately, diabetic
eye disease can cause severe vision loss or even blindness
if it’s not caught on time. But let’s take a closer look at
what each of these diseases are. We’ll first start by reviewing
diabetic retinopathy, which is the most common
diabetic eye disease. It occurs when diabetes
damages the tiny blood vessels that are inside your retina. If you have diabetic
retinopathy, at first you may not notice any changes
to your vision, but over time, it can get worse
and cause vision loss. On the right-hand side of your
screen you can see two photos. The photo at the top is
a representation of how the person with
normal vision sees. The photo at the bottom is
how a person with advanced diabetic retinopathy sees. It’s important to remember
that diabetic retinopathy has no early warning signs. Many years can pass before
a person with diabetes can notice changes in
his or her vision. In fact, the longer a
person has diabetes, the greater his or her chance of
developing diabetic retinopathy. If left untreated, diabetic
retinopathy can cause severe vision loss and blindness. The earlier you receive
treatment, the more likely treatment is to be effective. And the good news is that
95 percent of blindness from diabetic retinopathy can
be prevented through early detection, timely treatment,
and appropriate follow-up care. During the early stages of
retinopathy, it’s really important to control blood
sugar, blood pressure, and cholesterol to keep the
disease from progressing. In more advanced stages of
the disease, laser surgery can help shrink or kill
leaky blood vessels. Another surgical option for
reducing vision loss due to retinopathy is something
called vitrectomy. And in this procedure the bloody
vitreous gel, which is that clear fluid in your eye, is
replaced with a saline solution. So, it’s really important to
remind people with diabetes that they should have a comprehensive
dilated eye exam at least once a year to help detect diabetic retinopathy in its early stages before the person even realizes that they may have it
and have vision loss. So, next, let’s
move on to glaucoma. Glaucoma is often associated
with increased pressure in the eye, which can cause
damage to the optic nerve. When the optic nerve is damaged,
this can lead to vision loss. Again, at first there
are no symptoms. Vision stays normal, like
at the picture at the top on the right-hand
side of your screen. However, as the disease
progresses, a person with glaucoma may notice his or her
side vision gradually failing. That is, objects in front
may still be seen clearly, but objects to the
side may be missed, like in the bottom picture. As the disease worsens, the
field of vision narrows and complete blindness can result. Fortunately, if glaucoma
is detected early and kept under control, vision
loss can often be prevented. Therefore, it’s very
important that glaucoma is diagnosed in its early stages. Glaucoma treatments include
medicines, such as eye drops or pills, laser surgery,
conventional surgery, or maybe a combination
of any of these. While these treatments may
save remaining vision, they do not improve sight
already lost from glaucoma. So, people with diabetes
are at higher risk for developing glaucoma, and
it’s really important that we continue to educate
them about the importance of dilated eye exams
and early detection. Last but not least, let’s turn
our attention to cataract. A cataract is when the
lens of your eye gets cloudy. It can occur in one
or both eyes, but it does not spread from
one eye to the other. As we learned earlier, the
lens is made up mostly of water and protein. A cataract is formed when
some of the protein in the lens clumps together
and clouds the lens. Over time, this cloud may grow
and cover more of the lens, and it makes it harder to see. So, when a person first gets
a cataract, he or she may not even notice much change,
like in the top photo at the right-hand
side of the screen. However, over time the
person’s vision may start to become blurry, as if
they’re looking through a foggy window, or colors
may not appear as bright as they once did, like
in the bottom picture. As the cloud over the
lens continues to grow, it may be harder to read. A person may also start to
see more glare from lamps or cars’ headlights that are
coming towards them at night. To treat a cataract, an eye
care professional may first give a person eyeglasses,
suggest brighter lighting or antiglare sunglasses, or maybe have them use
magnifying lenses. But if these don’t help, the
doctor may perform surgery. The doctors will numb
the area around the eye, take out the cloudy lens,
and then they replace it with a new, artificial one. People with diabetes
are at higher risk for developing a cataract. So, again very important
to encourage them to have a comprehensive dilated
eye exam at least once a year. So, as we’ve been learning,
diabetic eye disease often has no early warning signs. Early detection is the key
to helping protect and maintain vision. For people with diabetes,
this means getting a dilated eye exam at least once a year. And this is different from the
eye exam that people get for contacts or glasses. During a comprehensive
dilated eye exam, the eye care professional will
place drops in the eyes to dilate or widen the pupils
so that they can see more of the back of the eye
and examine it for common vision problems and
signs of eye disease. He or she will use a special
magnifying lens to look for signs of diabetic
retinopathy, cataract, and glaucoma, and other
vision problems. And after the exam, close-up
vision may remain blurry for a little while, but your
vision will return to normal. So, that’s a really brief
overview of how diabetes affects the eye and how comprehensive
dilated eye exams can help protect and maintain vision. There are three
key takeaways from this section of the webinar. First, people with diabetes are
at higher risk for vision loss due to diabetic retinopathy,
glaucoma, and cataract. Second, these eye diseases
and conditions do not have early warning signs. So, people with diabetes
may be losing their vision without even noticing it. And third, early detection is
the key to protecting vision. People with diabetes
should have a comprehensive dilated eye exam
at least once a year. So, what are some of the ways
that we can help people with diabetes avoid vision loss? First, you can help educate
them about diabetic eye disease. You can also encourage them
to protect their vision by getting a comprehensive
dilated exam every year. And then, NEHEP
can help you with both of these important tasks. I’m now going to turn it over to
Marcela, who will introduce you to the Diabetes and Healthy
Eyes Toolkit and other NEHEP resources that will
help you spread the word about diabetic eye disease
and the importance of comprehensive dilated eye exams. Thank you so much, Neyal. And good afternoon to everyone. I’m so excited to be able
to share a brief overview of the Diabetes and Healthy
Eyes Toolkit with you today. I hope everybody has it handy,
because we’ll be taking a look at each of the resources
that’s included in the toolkit. We’re going to take a look
at how you can use them and how you can incorporate
them into your existing diabetes education
and outreach efforts, or start using them to begin
educating your community members about diabetic eye disease. So, if you haven’t already
done so, please go ahead and open your toolkit box. And I recommend that you
open only one end of the box, so that you can continue to
use it to store your toolkit. I’m going to go ahead and
start describing each of the resources that you’ll
find in the toolkit. So, please go ahead and
locate each resource inside the box and follow along
as I talk about each one. We’re going to start with
the largest and most obvious resource in the toolkit,
and that’s the flipchart. It’s a large flipchart that
can be used with small groups of people to educate them
about diabetic eye disease. The flipchart covers
eight very important topics. We start with the risk factors
for developing diabetes. We also discuss diabetes
and eye complications, the anatomy of the eye and its
function, and then we talk about the dilated eye exam, and we
take a closer look at each of the eye diseases and conditions. So, just as we did with Neyal,
we look at diabetic retinopathy, we look at the cataract,
and we look at glaucoma. And then we talk about
the importance of having an eye health team to help
you preserve your vision, get timely treatment,
and ensure that you are preserving your vision
as long as possible. Let’s take a closer
look at the toolkit. You’ll notice that the flipchart provides information for audiences on one side and
then talking points for facilitators on the other side. That way, the audience will
get the key information, and you’ll have speaking notes so
that you ensure that you provide all of the necessary messages to
motivate people to take care of their eyes if
they have diabetes. Inside the toolkit box,
you’re also going to find a small notebook. We call it the
educational module. And this is a booklet that
contains information about diabetic eye disease and then
provides recommendations on how to use the flipchart to
conduct an educational session for people who have diabetes. If you open the module,
you’ll see that it contains certain key sections. So, first, it provides an
overview of diabetes and diabetic eye disease. And this is to help
reinforce the knowledge that you have on
both of these topics. And then, it provides a brief
description on the role of health promoters,
community health workers. So, it discusses the type
of work that many of you are already doing
in your community. We also include instructions
for using the flipchart and tips for preparing
a presentation. As you read through the module,
you’ll also find step-by-step guidance for presenting the
flipchart, including how long the session should last, the
types of materials that you need, some talking
points, and then hints for your presentation. At the end of the module, you’ll
find a series of appendices. And these are handouts for
participants that you can photocopy or print and
then share with people who join you for your
educational sessions. I want to highlight
one very important appendix in the module. They’re all important, but I
particularly think you’ll be interested by this one. And it’s the Action
Plan for Participants. Now, this is a handout
that you give to participants at the end of an
educational session. So, once you’re done
presenting the flipchart, you will give this to
the participants and then have them fill it out. And what the Action Plan
does is allow participants to identify specific steps
they can take to maintain their overall health and
also their eye health. So, for example, getting a
dilated eye exam at least once a year and keeping their
glucose levels under control. Participants customize a plan
based on their own needs and what they feel
they can accomplish. And then, they can sign it as
a way to motivate themselves to carry through with a plan. The health promoter or
community health worker, in this case the community
health representative, can also sign it, almost
as a witness and as an assistant to help them
carry through on their pledge to take better care of their
health and their eye health. All right. We’re going to move on to
another resource in the toolkit. And this is the Watch
Out for Your Vision! If you have diabetes,
read this story booklet. And this is a comic book that
you can give to people with diabetes to help educate
them about the importance of getting a dilated eye
exam at least once a year. And through the comic book,
you’ll find the story of a woman who starts to learn
about the importance of comprehensive dilated eye exams for people who have diabetes. So, it’s an entertaining
way to provide important health information for
your community members. Another resource that
you’re going to find-and both the Watch out for
your vision! booklet and this resource that I’m
going to talk about now, the Medicare benefit card,
those can be found inside the small folder that’s included
as part of your toolkit. So, you open that up. You’ll find the booklet
and then you’ll find this Medicare benefit card
and a series of other materials that I’ll cover. So, this Medicare benefit
card helps promote the diabetic eye disease and glaucoma
benefit offered by Medicare. And it’s a resource that you
can order ahead of time and then hand out to the participants
who may be eligible for this benefit as a way of informing them and reinforcing the need to be treated for diabetic
eye disease and for glaucoma. Inside the folder, there’s
also a small magnet. And it’s called the
TRACK diabetes magnet. It gives tips to people
with diabetes about keeping their health on TRACK. And what does that mean,
keeping their health on TRACK? It’s an acronym where the
“T” stands for take your medication, reach and
maintain a healthy weight, add exercise to
your daily routine, control your blood
sugar, and then “K” for kick the smoking habit. So, T-R-A-C-K, track. Again, this is
another resource that you can give to participants. They can put it on their
fridge or somewhere handy, just as another reminder
to make sure that they’re getting a dilated eye exam
and then taking care of their overall health. Each copy of the toolkit
also contains a publications order form that you can use
to order free copies of the Medicare benefit card, the Watch out for your vision!
brochure, and the TRACK magnet. And as a bonus,
you can also order one free copy of the toolkit. The great thing about
this order form is that it’s postage prepaid. So, all you have to do is
select the resources you want, fill in your mailing
information, seal it with tape, and just drop
it in the mail. We’ll get it here over
at NEHEP and send the materials on
their way to you. We’ve also included an
evaluation form in the toolkit. And that allows you to
share your experiences and recommendations with NEHEP. Just like the materials
order form, this is also postage prepaid so that you
can just drop it in the mail. And we always value your
feedback and your comments. So, I highly recommend
that if you use the toolkit, if you could just please take
a few minutes to jot down how you used it, where you used it,
with whom, and then any thoughts that you might have about the
content or about the format and just drop that in the
mail and send it to us. Again, we would really
appreciate any feedback that you can provide. Now, in order to make it
as easy as possible for you to copy, print, and
present materials during your educational session,
we’ve also included a CD-ROM inside the toolkit. And this has PDFs of all
of the toolkit materials, from the flipchart down to
all of the appendices and the educational module. So, you just pop this into your
computer, and you’re able to access all of the resources
inside the toolkit. So, that’s it
for the toolkit. And now that you’re
familiar with the contents, I wanted to take a minute to
review how you would actually prepare to conduct an
educational session, and then what that educational
session would look like. So, in order to prepare,
first, of course, you want to make sure that you
review the flipchart and the module so that you are
as familiar as possible with the content and the process
of presenting the information. Next, you’re going to want
to identify a place to conduct your educational session. Now, this could be a
clinic waiting room, a senior center, a community
center, or even a living room. And then, of course, you’re
going to want to find and invite participants to
the educational session: people who have diabetes,
their loved ones, friends and family members-people
who would benefit from receiving this information. You should also go ahead
and order any NEHEP materials that you will need, so that
you can hand them out to the participants and you
can have them ahead of time. Also make sure that you
have copies of any of the handouts that you will use. Again, you can either
photocopy them directly from your module or print them
off of the CD-ROM that we included in the toolkit. Sometimes the session, when
it runs a little bit long, you might want to offer
a snack for your participants. And if you do so,
we just recommend that they’re healthy snacks. Because we’re dealing with
people who have diabetes, we want to make sure
we’re mindful of any dietary restrictions
that they might have. Some of the handouts that
you will use during your educational session
require that participants complete information,
fill out forms. So, you want to make sure
that you are collecting pens or pencils that the participants
can use during the session. And then, of course, you want
to make sure that you have your flipchart and
module ready to go. Now, in terms of the
educational session itself, there are many
ways to conduct it. And what we have done is
provided you just a general guideline, or some
general guidelines, on how to best
conduct the session. So, let me just review
that and then tell you a little bit more about
how it can be customized. So, one way to conduct the
educational session is first ask participants
to introduce themselves. That way, they get to
know each other and you get to know them
if you don’t already. And really, that only takes
about five minutes of your time. You can then have participants
complete the pretest, which is included in the
educational module. And this is going to
help you determine what participants know before
the session starts. Again, it should only take
about 10 minutes of your time. Next is really the longest part
of the educational session, and that’s presenting
the flipchart. It should take a little
less than one hour. So, we’re looking at
about 50 minutes to go from beginning to end
of the flipchart. Next, you’re going to
want to facilitate an educational activity,
which helps to reinforce knowledge for the participant. And the instructions for
that educational activity are actually included
inside of your module. So, you can take a
moment to review that. It should only take about
10 minutes to run through the activity itself. As we’ve already discussed,
we want to make sure that the participants fill
out an Action Plan. And that really only takes
about five minutes to help them identify the concrete
steps they can take to protect their vision. The Action Plan, as I’ve
mentioned before, is an appendix included in
your educational module. And then finally, you’re going
to want to close the session and have participants
complete a post-test. And this is going
to help you determine how much participants learned. So, as you’ll see, the
session is estimated to last about an hour
and 30 minutes. However, we understand that
not everybody is going to have all of this time to
present the content. Therefore, we recommend that
you review the module and the flipchart and identify
the content that you feel is the most important
for your group or for your community member. I’ve already mentioned some
ways that you can access the information in the toolkit,
whether it’s in the hard copy or on the CD-ROM, but I also wanted
to let you know that you can access the materials
on the NEHEP website. So, on the NEHEP website
you can download all of the toolkit materials,
and you’ll also find a PowerPoint presentation
that you can use instead of the flipchart. So, if you have access to
a laptop and a projector, you can actually grab this
PowerPoint, download it to your computer, and then
project it so that you have a different way to
share the information with your community members. The PowerPoint file also
includes the talking points just like the
flipchart does. So, you’ll have all the
information you need in one place ready to go. And the website URL is
right on your screen. It’s www.nei.nih.gov/diabetestoolkit. And we’ll present
this URL throughout the rest of the webinar. So, you can jot it
down as we continue. Also on the NEHEP website
at the same URL is an interactive online
training course that you can take to learn
how to use the toolkit. Now, the online course
contains a lot of the same information that we covered
in today’s training webinar, but it also covers
some additional content, including the educational activity that we’ve been mentioning throughout the
second part of the webinar. The online training course takes
about 45 minutes to complete. And the great thing is that
at the end, you’ll receive a personalized certificate. So, that’s the online
training course at www.nei.nih.gov/diabetestoolkit. In addition to the Diabetes
and Healthy Eyes Toolkit, NEHEP also has
numerous resources that you can download or
order on the website. And this includes materials
such as booklets and posters, fact sheets, articles,
infographics, and even public service announcements. And these materials cover a
range of eye health information, everything from general eye
health to glaucoma, cataract, low vision, sports-related eye
safety, and vision and aging. And you can see the URL
for these NEHEP resources right on your screen. It’s
www.nei.nih.gov/nehep. And again, we’ll repeat this URL
towards the end of the webinar so that you can note it down. So, that is the
introduction to the Diabetes and Healthy Eyes
Toolkit and to some of the other NEHEP resources. And we have some time
left for questions. So, I wanted to open
it up to any questions that you might have. And you can just use
the chat box to ask the presenters any
of the questions. And remember, the chat box
is located on the bottom left-hand side
of your screen. And I just want to mention
that if you ask a question and we’re not able to get to it,
someone is going to send you a response via email
after the webinar. So, we will try to get to
everybody’s questions, but in case we don’t, you will
receive a response afterwards. So, here we go, we’re
opening up the chat, and we’ll start answering
your questions. So, we have a
question coming in. This is for Neyal. Neyal, are people with
diabetes at higher risk for developing glaucoma or cataract? So, yes, I’ll just
reiterate from earlier. People with diabetes are
definitely at higher risk not just for diabetic
retinopathy but also for glaucoma and cataracts. And this doesn’t mean people
with diabetes aren’t also at risk–people who do not have
diabetes obviously are not at risk for diabetic retinopathy,
but they are at risk for glaucoma or
cataract as they age. It’s just that people with
diabetes are more likely to develop these
conditions as a result of the complications of diabetes. But it’s really important for
everyone to protect their eyes as they age, but especially
for people with diabetes, making sure that they have a dilated eye exam at least once a year to detect these conditions
and other things early is really, really important. Great. Thank you. And are there any financial
resources available for people who want to get eye exams
but can’t afford them? Yes. We have information
on the NEHEP website, which is here on your screen. There are organizations that
do provide financial assistance to help pay for eye care. Again, Medicare, as we
talked about earlier. And then, Cathy, I’ll let you
answer because I believe some people have asked if IHS pays
for eye exams, and I know that’s a question that’s
coming through. So, can you add onto that? Sure. I’m happy to do that, Neyal. American Indian and Alaskan
Native persons who are eligible to receive IHS services can
obtain those eye exams at their local IHS or tribal facility and, of course, if that facility is equipped to provide
those types of services. For those locations that don’t
have staff and equipment to provide eye exams, the patient
can contact his or her IHS or tribal primary care provider,
and together they can work with contract health services. And in our system,
CHS is now called purchased or referred care, PRC. They can work with their
doctor to ensure that a properly authorized referral and
commitment to pay are made. And I say that really because
eye exams without that kind of proper prior approval from
CHS will end up being the patient’s responsibility to pay. And then again, I’m just really
pleased with all of the other options that’s offered on
the NEI resource listing. So, thanks for that. Thank you so much, Cathy. And we have a number of
other questions coming in. So, we’re going to
move to the next one. Are there any
continuing education credits for the online training? That’s a great question. And unfortunately there are not. However, as I mentioned, we
do provide that certificate of completion at the end, and
some continuing education associations or providers actually do accept that type of certificate for CEU. So, I recommend that you go
online, complete the course, and get your certificate. And let me just mention
actually that everybody who has registered and logged on to
today’s webinar will receive a copy of the certificate
after the webinar is done. And it’s the exact
same certificate as on the online training course. You’ll be able to type in
your name, today’s date. And you can print
that certificate or save it to your computer. Okay. We’re going to move on
to the next question. Neyal, what should
people do if they have already lost some vision? That is a great question. So, we mentioned the term
low vision earlier when we were talking about some of
the resources earlier. Low vision means
that that vision that people have experienced; obviously, they have already
lost vision due to eye diseases like glaucoma or cataract or
diabetic retinopathy, vision that can’t be corrected
with glasses or surgery or anything else. So, it’s really important
that to know that there’s vision rehabilitation and services and devices out there that can help
people make the most of the vision that they do have. Every state has an Association
for the Blind that can be contacted to help people find
resources in their local area. So, that’s one way
to find information. Also, if you visit the NEHEP
website and look under our low vision program, we provide
links to resources of other organizations that help people who have already lost their vision so that they can
learn how to maintain their independence and quality
of life, to continue managing their diabetes. So, there is help
and hope out there. So, we just really want to make
sure that people know life isn’t over if you’ve lost vision. But there’s so much that can
be done for people with diabetes to prevent vision loss
in the first place. And I want to go back to
that number of 95 percent of vision loss can be prevented. And I just think that’s so
crucial to remember to tell people not to wait until they
notice problems with their vision to go get an eye exam. Just to make sure that they make
it part of their own diabetes health management to get a dilated eye exam every year. Thank you, Neyal. And that’s actually a great
segue into the next question. If a person has been diagnosed
with a diabetic eye disease, is there a cure or a
way to bring their vision back close to normal? So, the answer to that
unfortunately is no. With diabetic retinopathy–and
depending on how advanced it is and if the blood vessels are
really leaky and without getting into the technical stuff–there are some treatments where they can do injections into the
eye to stop some of the blood vessels from leaking and some
little bit of vision can be restored, but that vision that’s
already been lost is never going to go back to what it was. And that’s the
same for glaucoma. So, it’s really important again,
the early detection, the early treatment before it
happens is really the key. You really cannot really
restore vision that’s been lost. Thank you for that
important information, Neyal. We have another
question coming in. Are the handouts seen on the
NEHEP site able to be ordered like the toolkit material? So, the resources that we
showed, the brochures, the pamphlets, the magnet,
all of those resources can be ordered on the NEHEP website. You just go to
www.nei.nih.gov/nehep. And you’ll see the URL
right on your screen. And you will access the catalog
from that website where you can order the materials
that you need. So, a great question. Thank you very much for that. And can I just add
to that, Marcela? We just put up a slide that
has my contact information. So, if you’re looking for
something that you can’t find or if you have a question, please
email me, feel free to call me. We’re happy to provide
these resources to you. It’s really more important
to us that we get them out there and that you can use them. So, if there’s anything that
you do want, again, feel free to contact me, and we’ll
provide them to you. And we do not charge
for materials. There’s a shipping and handling
fee if you order them from the website, but if you contact
me directly and you tell me that you’re part of the CHR program, we’ll send you those materials for free, and we can waive
that shipping and handling. So, just let me know. Great. Thanks, Neyal. What kinds of
treatments are there for diabetic eye disease, Neyal? Again, that’s a
complicated question ’cause it really varies. Going back to diabetic
retinopathy, when it’s diagnosed early, really the treatment
is really controlled glucose levels and blood
pressure and cholesterol. And those are some of the key
things that can really preclude the disease from progressing
to advanced stages. But if the diseases do progress
and people have things like macular edema or other
things that can happen with retinopathy, there’s
laser surgery, there’s conventional surgery. There’s different
things that can be done. Again, I have to reiterate
’cause I think it’s so important about the early detection. The earlier it’s treated, the
more likely it is to work. Glaucoma is more complicated,
you know, because it has– it’s a very complicated
group of diseases. But usually, eye drops are one
of the ways it’s treated or through regular surgery. So, it can be treated
if it’s controlled. But again, vision loss
that’s already lost from it can’t be brought back. And then, cataract surgery is
typically the main way that cataract is treated,
especially when it’s in its advanced stages. Thank you, Neyal. And actually, that brings up
a very important question, which is what should CHRs, community
health workers, promotoras what should we do if we get asked
a medical question during one of our educational sessions? And I will go ahead
and answer that. So, as we do our health
education and outreach work, you know, these types of individual
questions do come up once in a while, and it requires very
specific medical knowledge or it requires that a, you know,
physician be involved to provide diagnosis and treatment. So, the best thing that we
can do when carrying out our educational session is
really to refer that person back to their primary care provider,
to their eye care provider, to the ophthalmologist so that they can provide the correct diagnosis and treatment options. That’s not our role
as community health workers and health educators. We provide the information. We make the link back to
the health professional. And those health professionals
are able to provide the more detailed in-depth
medical information. So, I know those of you who are
out delivering these educational sessions, this is a
situation that comes up a lot. So, just continue to
refer those people back to medical professionals. And I think that’s
the best way to deal with those types of questions. Neyal, we’re also getting
a question here about people who do not have diabetes. Now, can they develop
glaucoma and cataract, too? Anybody can develop these
diseases, especially the older you are, the more you are at
risk for some of these eye diseases, but there’s a
lot of things that people can do to protect their vision. I mentioned the
dilated eye exam, but there’s also lifestyle factors. Some of the very things that are
mentioned in that TRACK magnet that you mentioned earlier
about maintaining a healthy weight, exercising daily, eating a really well-balanced diet, especially foods like dark
leafy greens like spinach or kale or fish like that’s
high in omega-3 fatty acids like salmon or halibut. Those are types of food that
are really good and have shown to have eye health benefits. You mentioned the not smoking. I can’t stress that enough. Smoking is as bad
for your eyes as it is for the rest of your body. So, encourage
folks to not smoke. But also simple things like
eye protection from the sun. So, wearing sunglasses with
UVA and UVB protection and a wide-brimmed hat when you’re outside can really help protect your eyes, especially from
something like cataract, which we know that UVA and
UVB rays can cause. And wearing protective eyewear
when you’re playing sports or if you’re outside
gardening or doing the chores around the home. It’s really important to wear
protective eyewear to prevent things from flying
into your eyes. Great. Thank you. We also have a question about
ordering resources again. Now, are the resources available
for order only one time? No. So, the great thing about
a lot of these materials are first, they’re downloadable. So, if you want to just
download them and print them, you can do that as
many times as you want. Or if you need bulk copies,
that’s totally fine. Again, please contact me, and
I’m happy to give them to you many times ’cause again,
we really want to get these out into the community. So, we’re happy to provide them
as many times as you need them. Okay. And we have another
toolkit question coming in. For those of us who are
working in Spanish-speaking communities, are these
resources available in Spanish? And the answer is yes. The toolkit and many of the
resources that we shared with you are available
in Spanish. So, you can go ahead and order
them and distribute them, share them with your Spanish-speaking
community members. Again, that’s through the
website that we shared before, www.nei.nih.gov/nehep. And here’s a question on
the educational session. So, how many people
do you recommend take part in an educational session? That’s really a great question. And I want to say that, you
know, we recommend about 8 to 10 people take part in an
educational session. The flipchart was developed
for a small group setting. And this is a nice number
so that you’re getting good interaction between
the participants, with the facilitator. It’s a manageable number. However, as I mentioned earlier,
we see this as a very flexible resource, a very
flexible process. So, we know that some of you
only present to one person at a time, and that’s
absolutely fine. Some of you present to 25
or 30 people at a time. And again, absolutely fine. Really, the resource is meant
to be used as you need it. We provide the key information,
the guidance, and then you take that and integrate it into your
existing effort or you use it as best fits the circumstances
for your community. Let’s see. Yeah. We have a question about
getting a dilated eye exam. Where can people get
a dilated eye exam? A great question. I mentioned earlier that a
dilated eye exam is not the same thing that you get for
contacts or glasses, but your ophthalmologist or optometrist are both qualified to perform comprehensive dilated eye exams. So, when you go to the eye
doctor, you can ask for one. So, they’re the ones
that are trained. And that brings
up another issue. A lot of people ask about the
dilation versus the cameras. They know that there’s
people out there that can examine the eyes with cameras. So, yes, that is true. And, you know, it’s really great
for telemedicine when people don’t have easy access to an
eye care professional in their community, that the
cameras are great. They’ll take a picture of the
retina and they can see if it looks like there’s any
signs of disease or damage. So, those certainly work,
but the National Eye Institute really encourages folks to
get the dilated eye exam, have the eye care professional actually place the drops in their eyes and look at their eyes instead of looking at the picture just to make sure
that they don’t miss anything. So, again, visit your
local eye care provider. And if you don’t know where to
start looking for one, we have information on our website
to help people find a local eye care provider
in their community. So, again, look at
our website and you can find that information there. Thank you, Neyal. We’re getting a lot of questions
about the webinar itself. I just wanted to share with all
of you that the webinar is going to be made available to you
at a later date both on the NEHEP website and through IHS. So, you’ll be able
to view this again. But we’ll also be sending you
copies of the slides immediately after this webinar ends. So, you’ll have the slides and
then you will be able to go back to an archived version
of the webinar. Cathy, it looks like we
have a question for you. How can I follow up with
my patients to help them make changes to their
health behaviors? Wow. That’s another super question. I’ve been very impressed
with the Diabetes and Healthy Eyes Toolkit. They provide some great
resources in there for CHRs to use to help their patients
take small steps in order to make positive changes
in their lives. And one of those is
with that action plan. I think it’s Exhibit E in
the module booklet and on the CD itself that’s in the toolkit. Doctors and nurses
often use this type of tool with their patients. And in the Indian health
system, we call that the brief action plan or BAP. Kind of a funny name, but
that’s what it’s called. We recommend that CHRs share the
entire toolkit with their clinic staff, and then also discuss how they as CHRs plan on using it. And also check in with clinic
providers to see if there’s a local BAP form that the clinic
provider suggests they use and maybe they can even work with the clinical providers together to improve the clinic’s form
by incorporating elements of the action plan that’s found
within the toolkit itself. So, those are a few of the ways
that CHRs can follow up with their patients to help
them make those changes. That’s such an important part
of helping the patient do their own self-management and
what we call self-management support on the part of CHRs. They’re fabulous at
that kind of support and patients really appreciate that. So, thanks for
asking that question. Thank you so much, Cathy. We have another
question coming in. Suppose a patient’s dilated
eye exam shows damage, but the patient has no other symptoms. Is the progression to vision
loss not stoppable, Neyal? Well, again, that’s something
that a person needs to talk about with their
eye care professional. Again, early detection, if
they’re not noticing symptoms, the eye doctor is going to see
it, and they’ll decide what the best treatment is at that time. I have to stress the importance
of glucose control and a healthy weight and controlling blood pressure and cholesterol because a person can just have very mild
diabetic retinopathy and if they are really good at controlling
their diabetes and keeping up with their health, they
can stop the progression of it or really slow it down. So, those lifestyle
factors are so crucial. It does not have to progress. People do not have to
go blind from diabetes. I mean, I can’t stress that
enough, that there’s so many things that people can
do to protect their sight. So, if they are starting to
notice damage, while that damage can’t be reversed, it can be
prevented from going further. Very important. Thank you, Neyal. We’re also being asked
if there are any other webinars provided through NEHEP. The answer to that is yes. And thank you for asking. We have done other webinars that
are archived on our website. So, again, if you visit the
NEHEP website, that’s up there on your screen, there’s
a link to webinars. So, you can find
other information about eye health topics. And this is the first webinar
that we’ve done in conjunction with the Indian Health
Service, and we’re certainly open to doing more with you all. So, Cathy, you know,
we can talk in CHR. If you have topics about eye
health you’d like to see, let us know, and we’re always open
to doing more with you all. Another thing I just would like
to suggest if you’re interested in learning more about
our webinars and some of our materials and some of the things we have coming down the pike, if you visit our website,
you’ll see a link to our Outlook newsletter, which is our e-newsletter where we put out announcements and things that
are new, materials or things that our partners around the
country are doing that you may be able to get involved in. So, I’d encourage you to
sign up for our newsletter. And then, Cathy is also the
representative from the Indian Health Service with
the NEHEP program, and I know that she’s really great about
sharing all of our emails and forwarding them to you all. So, stay tuned that way, too. Very good. Another question on the toolkit. What sections of
the flipchart are the most important to present? That’s a really great question,
and I think it depends on your particular situation,
how much time you have, where you’re presenting. So, as I mentioned earlier, we
recommend that you just take a look at all of the content
that’s included in the flipchart, and then determine for yourself how much people may already know or not know about diabetes and about the anatomy of the eye and about
each of the diabetic eye diseases and conditions. So, it’s really up to you and
your particular circumstances, but we do have those three key
takeaways that Neyal covered. You know, first the lack
of early warning signs and symptoms, the need to get a
comprehensive dilated eye exam at least once a year if you
have diabetes, and then finally just that people
with diabetes are at higher risk for vision loss. So, those would be the three
key messages that you want to share with your educational
session participants or community members and use the flipchart, of course, as a way to deliver that information. So, we’re getting close
to the end of time. You guys have given
us great questions. Please keep them coming. For those we didn’t get a
chance to answer, we will get back to you, but in the
interest of everyone’s time, I really want to say how
grateful we are on the behalf of NEHEP to participate in
this webinar with you and to work with the Indian Health
Service and the CHR program to bring this information to you. It’s been a great partnership,
and we look forward to other ways to help you
meet the eye health education needs
in your community. So, on behalf of Marcela
and I, we really want to say thank you. And I’ll pass the torch on to
Cathy to give closing comments, but I express my
gratitude for you all. Thank you, Neyal. I really appreciate it. And, Marcela, you too. I really want to emphasize
to our folks and express my appreciation, Neyal,
for the years that we’ve had this opportunity to partner
together and also for your kind offer today, that I hope
that everyone took note of, about contacting you directly
for any kind of materials, and especially ’cause you know
how CHR programs are always very cost-conscious, so that
shipping and handling costs would be eliminated for them. I just am really appreciative
of that and of the many, many resources that this toolkit has. So, for everyone on the
call on the webinar, I have just a few
items before we finish. Once this webinar ends, an
evaluation form is going to appear on your screen. Please take a moment just
to answer a few questions. The presenters and
I value your feedback. So, please do that. Everyone who registered and
logged in to the webinar today is going to receive a certificate of
completion by email. The certificate can
be customized with your name and today’s date. So, you can print it or
save it to your computer, however you’d like to do that. However, certificates will not
be available to those who are viewing an archived
version of this webinar. We’ll be sending everyone
a copy of today’s slides, also archiving this webinar
on the NEHEP and IHS websites. So, with that I’d like to
thank you, everyone, for joining us in
today’s webinar. Please remember to
complete the survey. Goodbye.

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