Telemedicine for diabetics focuses on prevention

Expanding program screens patients for risk of blindness

By KEN CARLSON
kcarlson@modbee.com

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A telemedicine program is screening thousands of San Joaquin Valley diabetic patients for retinopathy, a condition that causes blindness in 24,000 diabetics each year in the United States.

Yearly eye exams are recommended for people with diabetes because of the damage the disease can cause to the retina, the membrane lining the back of the eye. Retinopathy is the leading cause of blindness among adults ages 18 to 65.

Only half of all diabetics receive regular eye exams, and the rate is much lower in poor and rural areas, where many uninsured patients can't afford to visit an optometrist.

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PDF Graphic: DIABETES AND VISION LOSS

Over the past two years, four health clinics serving the poor in Stanislaus and Merced counties have taken part in a pilot program to use telemedicine technology to screen patients. The program, funded by the nonprofit California HealthCare Foundation, is being expanded to 100 clinics in California with the aim of screening 100,000 patients.

Clinical staff take pictures of the patients' eyes in the clinics, then send the images to specialists at the University of California at Berkeley School of Optometry.

Participating clinics include Golden Valley Health Center in west Modesto, a Golden Valley clinic in Merced, the Castle Family Health Center in Atwater and Livingston Medical Group in Livingston.

During the pilot project, the UC Berkeley optometrists and ophthalmologists screened more than 12,000 patients from 13 clinics in the San Joaquin Valley and referred 15 percent of the patients for treatment of retinopathy, glaucoma or cataracts.

About 10 percent of the patients referred would have gone blind without treatment, program officials said.

The four area clinics and St. Joseph's Medical Center of Stockton are involved in the expanded program.

Before using telemedicine, Golden Valley's primary care clinic in west Modesto advised diabetic patients to get regular eye exams, but apparently few of them did.

Christine Noguera, deputy executive officer for the Golden Valley clinics in Stanislaus and Merced counties, said a chart review of 29 patients screened through the telemedicine program revealed that none had received a documented eye exam.

The program enables the Golden Valley center in Modesto to screen about 50 patients a month for retinopathy. Usually, seven or eight patients need referral to an ophthalmologist for consultation and treatment.

Diabetic patients are given the screenings when they come in for medical checkups. For uninsured patients, the cost of the screening is included in the discounted fee for the office visit.

Medical Assistant Michelle Rod- riguez, who was trained to use the $24,000 camera furnished by the program, said it takes 10 to 15 minutes to get clear pictures of the back of a patient's eyes. She loads the images into a server, and the UC Berkeley optometrists e-mail the results of the evaluations within 24 hours.

Jorge Cuadros, a clinical professor of optometry at UC Berkeley, said half of the patients screened during the pilot period had some retinal damage.

"We have seen a lot of people on the verge of going blind," Cuadros said. "What usually happens is that the patient doesn't know until they have serious complications."

Other ailments uncovered

The optometrists noticed something different when they looked at pictures of a patient at the Golden Valley clinic in Merced. They advised the man to have a brain scan as soon as possible. He complied and a week later underwent surgery to remove a brain tumor, Cuadros said.