Vision in Children

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How Teleretinal Imaging Technology Can Help Improve Patient Access to Diabetic Retinal Exams

Early Detection Is Key

Diabetic retinopathy is the leading cause of blindness among working-age adults.1 More than 400 million people globally currently live with diabetes and by 2040 the number will grow to 642 million2—80% of diabetics will eventually develop some level of diabetic retinopathy.3

Despite the fact that early detection and treatment can prevent up to 95% of vision loss cases,4 typically only half of patients with diabetes see an eye specialist for an annual retinal exam.5 These numbers should alarm anyone treating patients living with diabetes.

"Tie those numbers to the insufficient rate of diabetic retinopathy diagnoses, and it becomes clear that a better solution is necessary to help improve early diagnosis and care."

One of the best opportunities to help eradicate a leading cause of preventable blindness related to diabetic eye disease is to arm primary healthcare providers with simple and affordable teleretinal imaging technology that enables retinal assessment during a patient’s routine office visit.

By making diabetic retinal exams more accessible in primary care settings, more patients who would normally not receive an annual exam, can be conveniently checked and referred, if necessary, to obtain timely, vision-saving treatment. This is the first crucial step to help eradicate one of the leading causes of preventable blindness.

The Current State of Care

Research points to numerous challenges that prevent patients with diabetes from being checked for diabetic retinopathy. These include insufficient referrals, socioeconomic factors, geographic access to care, lack of patient education, and cultural barriers among minorities and indigenous populations.

“The tragedy of diabetic eye disease is that it’s the most common cause of vision loss in working-age adults, and less than half of the patients who have diabetes get screened in any given year,” said Edward Chaum, M.D., Ph.D., Chief Medical Officer, RetinaVue®, P.C.

The current standard of care for a patient with diabetes is to have a dilated retinal examination by a qualified eye specialist, usually on an annual basis if no disease is present, more often if warranted by the level of disease. This standard would be adequate if every person living with diabetes complied with their annual referral to visit the eye specialist—but only half comply.

Consequently, the current standard of care is not adequate, and a paradigm shift is necessary in order to realize a significant decrease in the number of people suffering from severe vision loss and blindness as a result of undiagnosed diabetic retinopathy.

A New Care Delivery Model

More than a decade ago, the American Academy of Ophthalmology indicated that single-field fundus imaging—used in most teleretinal imaging technology—can successfully capture and detect diabetic retinopathy. Those patients with disease detected should be referred for ophthalmologic evaluation and management.6 Another study evaluated single-field fundus images in 2002 and found them to be highly correlated (K = 0.97, P = 0.0001) to the gold standard—seven-field stereo mydriatic images.7

While teleretinal imaging technology is not new and has been proven successful, there have been significant barriers to widespread adoption of this technology in primary care settings—mainly cost, device size, and absence of easily accessible diagnostic interpretation services by a nationwide network of board-certified ophthalmologists. With office space, capital, and caregivers’ time at a premium in most primary care practices, the adoption of large, more-expensive desktop fundus cameras (designed primarily for eye specialists) has just not been practical.

Recently, Welch Allyn® introduced an effective, affordable, and scalable primary care model to help increase documented diabetic retinal exam compliance and improve patient outcomes and quality measures. The Welch Allyn RetinaVue® care delivery model is designed specifically for primary healthcare settings and includes three main components:

  1. Tabletop or handheld retinal cameras to obtain high-quality retinal images. Image capture takes less than five minutes and generally does not require dilation for an estimated 85% of patients. Many providers choose the simple and affordable RetinaVue 100 Imager—the world’s most advanced handheld retinal camera.
  2. HIPAA-compliant RetinaVue Network software to transmit encrypted retinal images to your preferred eye specialist and manage population health data on retinal exams by clinic and patient. A software plan is required (priced per camera, per month) and includes fully integrated, bi-directional interfaces with EMRs to streamline documentation.
  3. Ophthalmologists and retina specialists at RetinaVue, P.C., who interpret the retinal images and prepare a comprehensive diagnostic report and referral care plan generally within one business day—complete with ICD codes, signature and license number. Professional medical services offered by RetinaVue, P.C., are priced on a per exam basis. Alternatively, you can use your preferred eye specialist.

“What makes this camera different from everything else on the market is its compact size, low price, and ease of use,” said Dr. Chaum. “The RetinaVue 100 Imager provides primary care providers with the opportunity to evaluate patients simply, quickly and cost-effectively. This revolutionary camera is the key to making a very significant impact on reducing vision loss and preventing blindness from diabetes.”

The Benefits of Diabetic Retinal Exams in Primary Care Settings

Providing diabetic retinal exams in primary care settings can increase documented patient compliance to over 90% within one year,8 helping ensure that vision-threatening diabetic retinopathy is detected early enough to prevent blindness and increasing quality measures for the practice. Accurate documentation of chronic conditions helps inform care planning, care delivery, appropriate coverage and quality performance.9 The quality measure for annual diabetic retinal exams (NQF #0055) is included in Medicare Advantage Star Ratings, CMS Quality Payment Program and Medicare Shared Savings Program measures.

Additionally, most commercial healthcare plans provide coverage for diabetic retinal exams in primary care settings. Many healthcare providers enjoy a favorable return on investment within their first year.

How the RetinaVue Care Delivery Model Works

The RetinaVue care delivery model is a complete, turnkey solution, providing everything necessary to perform diabetic retinal exams in primary care settings.

To start, any healthcare professional in the primary care practice can capture high-quality fundus images in minutes with minimal training using either the new RetinaVue 100 Imager or a full-size fundus camera such as the CenterVue DRS Retinal Camera for clinics with higher patient volume.

Next, encrypted fundus images are transmitted via the secure HIPAA-compliant RetinaVue Network software to be evaluated exclusively by a nationwide group of board-certified ophthalmologists at RetinaVue, P.C.—expert interpretation services are a necessary component of the RetinaVue care delivery model. Alternatively, images can be transferred to your preferred eye specialist for interpretation.

Lastly, a complete diagnostic report is returned typically in one business day. The diagnostic report includes retinal images, all relevant ICD codes, a referral/screening plan that clearly details next steps for the patient, as well as the retinal specialist’s signature and license number.

Every RetinaVue care delivery model software plan includes convenient free access to recent and historical retinal reports via the secure, online clinic portal that permits users to receive, store and manage retinal reports as well as review statistics on exam volume, diagnoses and image quality. An industry-standard HL7 interface is available for integration into commercial electronic medical record platforms. Of course, Welch Allyn technical support is included. 

Key Takeaway

As the data shows, a shift in the standard of care for detecting and treating patients for diabetic retinopathy is necessary. Making teleretinal imaging technology more practical for primary care settings can help health systems achieve the “Triple Aim” of improving the patient experience, improving population health, and reducing costs.

Interested in learning more about teleretinal imaging? Be sure to check out our eBook to find out how this technology can benefit your patients and practice.

 

References

1CDC Vision Health Initiative (VHI), Common Eye Disorders. www.cdc.gov/visionhealth/basics/ced/index.html

2IDF Diabetes Atlas, Seventh Edition 2015, page 50. www.idf.org

3Preferred Practice Pattern® Guidelines, page 6. American Academy of Ophthalmology; 2014. www.aao.org/ppp

4National Eye Institute, Facts about Diabetic Eye Disease. https://nei.nih.gov/health/diabetic/retinopathy

5Monitoring Visual Status: Why Patients Do or Do Not Comply with Practice Guidelines; Frank A. Sloan, Derek S. Brown, Emily Streyer Carlisle, Gabriel A. Picone, and Paul P. Lee; HSR: Health Services Research 39:5 (October 2004)

6Williams GA, Scott IU, Haller JA, Maguire AM, Marcus D, McDonald HR. Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. Ophthalmology. 2004;111 (5):1055-1062.

7Lin DY, Blumenkranz MS, Brothers RJ, Grosvenor DM: The sensitivity and specificity of single-field nonmydriatic monochromatic digital fundus photography with remote image interpretation for diabetic retinopathy screening: a comparison with ophthalmoscopy and standardized mydriatic color photography. Am J Ophthalmology 134:204 -213, 2002.

8Comparing the Effectiveness of Telemedicine and Traditional Surveillance in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial; Mansberger et al, Telemedicine and e-Health, Vol. 19 No. 12, Dec. 2013.

9Understanding the Role of HCCs in Risk-Adjustment Programs; A Comprehensive Primer for Hierarchical Condition Categories, ©2017 Advisory Board, www.advisory.com

 


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