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Telemedicine brings doctor to people with diabetic eye disease

Telemedicine can increase the number of people with access to medical evaluation for diabetic retinopathy, particularly for minority, rural, and typically underserved populations, new research suggests.

Seema Garg, a retina specialist and associate professor in the department of ophthalmology at the University of North Carolina at Chapel Hill, has been spearheading efforts since 2009 to implement and study telemedicine programs to improve early detection of diabetic retinopathy.

…reducing vision loss from diabetic retinopathy is a public health imperative.

Garg and her team established the North Carolina Diabetic Retinopathy Telemedicine Network to implement a pragmatic approach to improve surveillance for diabetic retinopathy, the leading cause of preventable blindness in the United States and the leading cause of blindness among working-age Americans.

They recruited patients with diabetes who live in rural and underserved areas of North Carolina by collaborating with five clinical sites that serve this population (AHEC clinics).

At each site, they trained primary care staff to obtain digital retinal photographs that they then securely transmitted to Garg for remote evaluation.

In the first of two papers in JAMA Ophthalmology, Garg’s team demonstrates that when implemented in primary care settings, retinal tele-screening increased the rates of diabetic retinopathy evaluation in rural and underserved areas and increased access to care among minority populations and others at particularly high risk for vision loss.

Furthermore, they examine demographic and clinical factors that require ophthalmology referral. Notably, these are minority race and older age, as well as history of kidney disease and stroke.

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In the first study of its kind, in a companion to the first paper, Garg and colleagues demonstrate that Geographic Information Systems (GIS)-mapping is a useful technique for visualizing geographic access barriers to eye care for patients with diabetes.

By mapping the statewide distribution of providers serving the primary care needs of diabetic patients alongside ophthalmologists in North Carolina relative to the ZIP codes from which patients travel to reach the five AHEC clinics in their network, they showed that patient accessibility to these doctors is influenced by the geography and road networks that connect them.

This knowledge may help inform the future expansion of the telemedicine programs as they are now able to identify opportunities for strategic collaborations between primary care providers and ophthalmologists across North Carolina. Garg believes that reducing vision loss from diabetic retinopathy is a public health imperative.

In these two papers, Garg and colleagues demonstrate that, in rural settings, telemedicine is extremely effective in improving access to retinal evaluation.

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Telemedicine screening can increase surveillance rates, reduce socioeconomic disparities, and increase access to care—ultimately preventing vision-threatening DR to improve visual outcomes and quality of life for patients with diabetes.

Garg, lead author of both papers, received funding from the Duke Endowment for the work.

Source: UNC Chapel Hill

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