Using Telemedicine to Increase Eye Care Screening & Referral for People with Diabetes

Diabetes is the leading cause of preventable blindness among adults aged 20-74 years. Millions of Americans are affected by the complications and premature morbidity and mortality rates associated with diabetes mellitus (DM). We deal with two of these complications, visual impairment and blindness from diabetic retinopathy, that imposes a significant, increasing burden on patients, providers, and the health care system. These burdens are predicted to approximately triple over the next few decades. A major issue is that many people with diabetic retinopathy do not seek eye care, even if they are covered by insurance, because the disease is often symptom free until vision is significantly compromised. At this late stage, visual impairment is more difficult and more expensive to manage and often the damage is irreversible. A possible solution to increasing screening for diabetic retinopathy is Digital Teleretinal Imaging. We review the literature on this technology and offer a screening approach using non-mydriatic Digital Teleretinal Imaging. We explore advantages and limitations of this strategy and discuss the role that state public health agencies can play in facilitating further research and implementation. We conclude that this technology offers significant patient, clinical, and public health benefits through mass public screenings. in