Despite the availability of effective treatment for diabetic retinopathy for nearly 3 decades, early detection is still critical to prevent vision loss. The Department of Ophthalmology and the Mayo Employee Health Services in Rochester, Minnesota, have teamed to ensure that Mayo Clinic employees with diabetes keep watch on their vision.
The retina photography project alerts diabetic patients to signs of eye disease so that they can receive early treatment and avoid potential vision loss. At selected Mayo primary care clinics, technicians use cameras to provide a retinal photograph that can detect the earliest signs of diabetic eye disease. Photographs may be obtained when employees are seeing their primary care physicians for regular diabetic management.
Following an established dilation protocol that includes visual acuity testing and applanation tension, technicians acquire 30° color fundus photographs centered on both the macula and the optic nerve. The retinal scans are transferred electronically through a secure portal to the Department of Ophthalmology, where they are interpreted by Andrew J. Barkmeier, M.D., a vitreoretinal specialist.
If Dr. Barkmeier sees any indication of diabetic eye disease, the patient is offered a complete eye examination and transferred from the photographic screening program to a periodic examination area in the Department of Ophthalmology. The retinal scans also become a permanent part of each patient's electronic medical record.
Nationwide, fewer than 50% of people with diabetes have yearly eye examinations, often because eye care is not controlled by the primary care physician or diabetes specialist. Project leaders hope that by providing convenient access to retinal photographs in the primary care setting, they can increase the rate of annual eye examinations for Mayo employees with diabetes to 100%.
The retina photography project is directed at diabetic patients who have relatively good control of their diabetes and may not feel a need to schedule annual eye examinations. Rajeev Chaudhry, MBBS, a primary care physician, and Dr. Barkmeier agree that patients today are generally well educated about diabetes and the need to monitor blood glucose levels. Many patients, however, do not appreciate the seriousness of diabetic retinopathy and do not see an ophthalmologist until they have symptomatic vision loss.
The cost of a fundus camera and associated hardware and software is approximately $25,000 per site. Photographic screening for diabetic eye disease is not reimbursed by Medicare, Medicaid, or most commercial payers. Project leaders anticipate, however, that task transfer associated with new technology, convenient access, and ophthalmology oversight will improve diabetic retinopathy screening efficacy and reduce costs.