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Currently, diabetes is identified in eye clinics in an advanced stage, only after visible signs of diabetic retinopathy. Recent ophthalmic research has identified multiple subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease. The corneal epithelium exhibits increased defects and poor healing, including an increased risk of neurotrophic keratitis. Increased thickness and stiffness of the cornea artificially alters intraocular pressure. There is damage to the endothelial cells and changes to the bacterial species on the ocular surface, both of which can increase risk of complications with surgery. Decreased corneal sensitivity due to a loss of nerve density predispose patients with metabolic disease to further neurotrophic complications. Patients with diabetes have increased Meibomian gland dysfunction, blepharitis and reduced tear production, resulting in increased rates of dry eye disease and discomfort. Early detection of metabolic disease may allow eye care providers to be more proactive in recommending referral and intervention in order to reduce the risk of blindness and other diabetes-related morbidity. Continued research is needed to better understand the time course of changes to the anterior segment and what can be done to better detect and diagnose patients with prediabetes or undiagnosed diabetes and provide improved care for these patients.<\/jats:p>","DOI":"10.1136\/bmjdrc-2019-001094","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T09:39:33Z","timestamp":1587029973000},"page":"e001094","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Eye care providers\u2019 emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review"],"prefix":"10.1136","volume":"8","author":[{"given":"Kathryn","family":"Richdale","sequence":"first","affiliation":[{"name":"College of Optometry, University of Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7665-0569","authenticated-orcid":false,"given":"Cecilia","family":"Chao","sequence":"additional","affiliation":[{"name":"College of Optometry, University of Houston, Houston, Texas, USA"},{"name":"School of Optometry and Vision Science, University of New South Wales\u2014Kensington Campus, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Health and Human Performance, University of Houston, Houston, Texas, USA"},{"name":"Biology and Biochemistry, University of Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"key":"2025073113065610000_8.1.e001094.1","unstructured":"WHO . 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