Hypertension and diabetes: a clinicolegal review.

The optometric management of patients with essential hypertension and diabetes mellitus is determined by both clinical and legal requirements. The most common cause of litigation is failure to recognize retinal changes requiring treatment, combined with a failure to refer. To comply with appropriate standards of care, an optometrist should perform a thorough eye examination (including evaluation of the retina with a dilated fundus examination), educate patients concerning the risks of hypertension or diabetic retinopathy and the need for periodic assessment, describe pertinent findings to the patient's treating physician, schedule patients for periodic reevaluation (as required by examination findings), and refer patients promptly if sight-threatening retinal changes are encountered.