Diabetic Retinal Examinations in Frontline Care Using RetinaVue Care Delivery Model

Abstract

P oint-of-care testing is now possible in many areas of clinical medicine. The ability to move testing closer to the patient has been possible for three decades with continuing advances in technology that have steadily produced more sophisticated devices. Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults in the United States. Diabetic retinopathy is caused by high blood glucose levels that damage the small vessels in the retina of the eye—over time resulting in bleeding, fluid leakage, and swelling. There are typically few or no symptoms in the early stages. Once vision loss begins to occur, the disease is often too advanced to treat effectively. Because of the lack of early symptoms, early detection of DR is critical and can prevent permanent vision loss in up to 95% of individuals. Patients can receive treatment via laser therapy or injections to preserve useful vision and stop the advancement of retinal damage. The American Diabetes Association recommends annual eye examinations starting 10 years after diagnosis for type 1 diabetics and starting at diagnosis for type 2 diabetics. Despite the awareness of the risks associated with DR, as many as 50% of patients with diabetes do not receive routine retinal examinations. There are several barriers to patients receiving receipt of an annual diabetic retinal examination, which is traditionally performed via pupil dilation at an ophthalmologist's office. These barriers include existing patient work flow, patient compliance, lack of insurance and health care access, low health literacy, cultural and language barriers, patient logistics, time, and cost for specialist visits. However, capturing patients during routine primary care office visits can achieve up to 90% documented compliance in 12 months. These frontline care-based programs typically use telemedicine to capture retinal images in the office and send the images for remote interpretation. Then, only patients with referable levels of DR are required to follow up with an eye specialist. The Welch Allyn RetinaVue care delivery model is designed to help primary healthcare providers preserve vision in patients with diabetes through early detection of DR. RetinaVue uses specialized cameras (nonmydriatic) that can capture retinal images on patients livingwith diabetes. The images are sent throughHIPAA-compliant RetinaVue Network software to an ophthalmologist for interpretation. The ophthalmologist generates a report, including any disease found and a management plan for the patient, which gets returned to the originating practice. This turnkey (point-of-care testing) solution allows frontline care providers to evaluate for and manage DR directly through their clinic.