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 Researchers at the Atlanta VA Medical Center used two years of
medical records to analyze what happened when retinal cameras were
placed in primary care clinics to monitor for diabetes-related eye
problems. Trained nurses used the specialized cameras to take
pictures of the retinas of patients with diabetes, which were then
sent to eye specialists or medical image readers for analysis.
If an image reader spotted a sight-threatening abnormality, the
patient was referred to an ophthalmologist at a separate but
affiliated clinic.
“It’s a very useful way to screen patients who are at a high risk
for eye problems, like diabetic patients,” Dr. Mary G. Lynch told
Reuters Health. “The VA has made a very big priority of putting
cameras in all the little outpatient primary care clinics, but it
would be nice to know what to prepare for in the big house,” she
said, referring to the eye clinic where the patients are sent.
Lynch worked on the study in the Ophthalmology Section of the
Atlanta VA Medical Center in Decatur, Georgia.
Diabetes can cause eye conditions like retinopathy or macular edema,
which may lead to blindness. Many U.S. medical authorities recommend
annual eye checks for people with diabetes, but patients are often
not aware of their vision risk (see Reuters Health story of December
24, 2013 here: http://reut.rs/1mPpKZq).
Lynch and her team examined the medical records of the nearly 2,000
patients who were screened at local VA clinics between the fall of
2008 and the spring of 2009, 465 of whom were referred to an eye
care clinic.
Patients were most commonly referred for nonmacular diabetic
retinopathy or nerve-related problems, according to results
published in JAMA Ophthalmology.
Just over half of those who were referred were actually seen in the
eye clinic within two years. But 36 percent of the people who did
keep their appointment at the eye clinic needed at least three
visits, indicating serious eye problems, Lynch said.
“We have pointed out a lot of glaucoma suspects, with a suspicious
looking nerve, and that’s a blinding and curable condition,” she
said.
So-called teleretinal screening is cost-effective because it avoids
many unnecessary in-person consultations while accurately
identifying patients who need referral to an ophthalmologist for
further care, Dr. Beau B. Bruce told Reuters Health by email.
Bruce, from the department of ophthalmology at Emory University
School of Medicine in Atlanta, works with Lynch’s team but was not
part of the new study.
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“The authors showed that there was good agreement and sensitivity
for the conditions studied (i.e., there was no sacrifice in the
quality of the care),” he said. “Likely this screening brought
sight-threatening disease to earlier attention and therefore
treatment.”
The results of this study could help other health systems decide how
to divvy up their eye care resources when they bring in the cameras,
Lynch said.
Nearly a quarter of the patients screened at the VA clinics were
referred to an eye clinic. That figure may be a bit higher than in
other health systems, given that the Atlanta VA is located in a
region with many other health issues, she said.
But health systems can still get a sense of what types of eye
problems will be most common among referred patients. That can help
the eye care clinic affiliated with teleretinal screening programs
allot medications and specialist doctors to deal with the influx of
patients, she said.
“These resource issues are all addressable ahead of time,” Lynch
said.
Teleretinal screening has its uses, said Dr. Hugh R. Taylor,
president of the International Council of Ophthalmology and a
professor at the University of Melbourne in Australia. But even in
the closed system of the VA almost half of patients who were
referred did not show up for their eye clinic appointment, and the
screening may not work as well in the general population, he told
Reuters Health.
“The real issue is having the equipment to capture the images, take
the photos, and people who can use it,” Taylor said.
SOURCE: http://bit.ly/SrjxK6 JAMA
Ophthalmology, online May 29, 2014.
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