Tele-Retina Diabetic Eye Exams in Primary Care Offices

Purpose: To increase the compliance in patients with diabetes to complete the recommended diabetic eye exams in order to rule out diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness among U.S. working-age adults per the National Eye Institute. It is expected that by 2050, there will be close to 14.6 million Americans living with diabetic retinopathy with Hispanic Americans being disproportionately affected. Diabetic retinopathy is treatable and more readily so in the early stages of the disease. The American Diabetes Association (ADA) has outlined in their standards of medical care in diabetes 2020 which state that comprehensive eye exams be performed every 1-2 years if there is no evidence of retinopathy and at least annually if any level of diabetic retinopathy is present.

Description: In a large academic medical center in Southern California where close to 6,000 diabetic patients receive care, around 40% of those patients were not completing the recommended diabetic eye exam. A root cause analysis was performed to determine reasons for noncompliance, and it was found that many patients deemed the testing to be inconvenient. Diabetic eye exams had historically been done in one clinic location that services much of the larger metropolitan area for their eye care and was notoriously difficult to receive an appointment. A workgroup was formed that consisted of ambulatory care clinic leaders, ophthalmologists, physicians, and nurses to develop a strategy that would increase the likelihood that patients would receive their diabetic eye exam. After extensive research on varying options, the team decided to pilot three retinal cameras in internal medicine and primary care clinics that would send patient images electronically to ophthalmologists. The team sought to answer for the diabetic patient population: how does offering retinal imaging in primary care offices compared to referring patients to another clinic for their diabetic eye exam affect patient compliance in receiving the diabetic eye exam during a pilot phase from October 12, 2020, to December 31, 2020.

Evaluation/Outcome: The pilot is still ongoing with varied success. Workflow continues to evolve along with clinical staff and provider engagement. However, during the first three weeks of testing, the pilot has provided some promising patient outcomes. In one example, a clinic imaged a 38-year-old patient who had never had an eye exam previously and was found to have severe proliferative diabetic retinopathy. The in-clinic exam enabled swift referrals to acute care that the patient would not have had otherwise.

More data will be collected in order to validate the proposed PICOT question; however, patients reported satisfaction in the “one-stop shop” availability for their diabetic care suggesting that the implementation of tele-retina eye exams in clinic may prove successful.