Diabetic retinopathy is the leading cause of blindness among working-age adults.
More than 400 million people globally currently live with diabetes and by 2040 the number will grow to 642 million—80% of diabetics will eventually develop some level of diabetic retinopathy. Despite the fact that early detection and treatment can prevent up to 95% of vision loss cases, typically only half of patients with diabetes see an eye specialist for an annual retinal exam.
These numbers should alarm anyone treating patients living with diabetes. 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 a simple and affordable screening system that enables retinal assessment during a patient’s routine office visit. Welch Allyn RetinaVue™ is leading the way with a simple and affordable turnkey solution to screen for diabetic retinopathy in primary care settings. RetinaVue consists of the RetinaVue™ 100 Imager, the HIPAA-compliant RetinaVue™ Network, and a team of board-certified retinal specialists who return a complete diagnostic report and referral/ screening plan the same day. Making diabetic retinal screening more accessible in primary care settings means more patients who are not receiving regular annual diabetic retinal exams can be conveniently checked and referred to obtain timely, vision-saving treatment. This is the first crucial step to help eradicate one of the leading causes of preventable blindness.
Diabetes is an epidemic; there are 44 million (12.9%) people living with diabetes in North America today, and by 2040 there will be 60 million (14.7%). 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. But not enough patients are being screened for diabetic retinopathy. Of the approximately 143 million people around the world living with some form of diabetic retinopathy, most never even know they have the condition until it’s too late. Research points to numerous challenges that prevent patients with diabetes from being screened 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
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 realise a significant decrease in the number of people suffering from severe vision loss and blindness as a result of undiagnosed diabetic retinopathy.
A new standard of care
More than a decade ago, the American Academy of Ophthalmology indicated that single-field fundus imaging—used in most teleretinal screening solutions—can successfully screen for diabetic retinopathy and detect those patients with disease for referral to eye specialists for ophthalmologic evaluation and management. 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.
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 retinal specialists. 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 has introduced a low-cost and easy-to-use turnkey solution to examine patients for diabetic retinopathy in primary care settings. Patients with diabetes can be comfortably screened in just minutes as part of their routine visit, avoiding the lost time and cost associated with a separate visit to an eye specialist.
The new handheld RetinaVue 100 Imager makes retinal assessment in primary care settings truly practical by shattering the price barrier at two-thirds less than desktop fundus cameras! The RetinaVue 100 Imager is also very easy to operate. With minimal training, any healthcare professional in the office can capture and transmit high-quality fundus images over the RetinaVue Network. Critical features include touchless image capture and autofocus technologies, as well as integrated image quality assessment software.
“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.”
Benefits of diabetic retinal assessment in primary care settings
Screening for diabetic retinopathy in primary care settings can increase compliance with the diabetic retinal exam (DRE) to over 90% within one-year, helping ensure that vision-threatening diabetic retinopathy is detected early enough to prevent blindness and increasing DRE quality metrics for the practice.
By intercepting patients during routine primary care office visits, healthcare providers can potentially qualify for financial incentives under the Medicare Benefits Schedule for photography with non-mydriatic retinal cameras. The service will enable General Practitioners to promptly provide this service at the point of consultation rather than referring at-risk patients to another health practitioner.
How Retinavue works
Welch Allyn RetinaVue is a complete, turnkey solution, providing everything necessary to screen for diabetic retinopathy 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 the new RetinaVue 100 Imager.
Next, encrypted fundus images are transmitted via the secure HIPAA-compliant RetinaVue Network for evaluation.
Lastly, a complete diagnostic report is developed and includes retinal images, all relevant ICD codes, a referral/screening plan that clearly details next steps for the patient, as well as the healthcare provider's signature and provider number.
Every RetinaVue Network subscription includes convenient free access to new 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.
As the data shows, a shift in the standard of care for detecting and treating patients for diabetic retinopathy is necessary. Making the technology more practical for primary care settings can help make a significant impact—not only on improving patient care, but also on helping practices to improve compliance and increase screening quality metrics.