More than 80 percent of people living with diabetes will develop diabetic retinopathy (DR) at some point in their life. However, with early detection, more than 90 percent of severe vision loss can be prevented.
The first step
While many patients with diabetes may not be able to see an eye-care specialist regularly, they will see their primary care physician (PCP) three to four times annually on average. Therefore, by introducing telemedicine technology at the point of care, a PCP could substantially reduce barriers to access and improve rates of early detection of DR.
Using a retinal camera, a trained clinical staff member can take high-resolution digital retinal photographs and securely transmit them over an internet-based network to a board-certified eye care specialist for evaluation. If evidence of DR is detected on the retinal photograph, the patient can be referred for further evaluation and treatment by an eye-care specialist. This telemedicine process is known as digital-retinal imaging with remote interpretation and has been shown to be successful in several settings across the country.
Increased access to care
On July 27, 2018, representatives Tom Reed (R-NY) and Terri Sewell (D-AL) introduced H.R. 6639 — “Diabetic Vision Loss and Blindness Prevention Act of 2018” — to provide Medicare coverage for digital-retinal imaging with remote interpretation in primary-care settings for beneficiaries with diabetes. This remote exam will not replace the annual diabetic eye exam but instead is intended to reach and evaluate those beneficiaries who do not regularly see an eye-care specialist.
With the prevalence of diabetes projected to increase from 25 million Americans to 125 million Americans by 2050, the number of Medicare beneficiaries requiring annual retinal exams will soon exceed the capacity of eye care providers. By implementing digital-retinal imaging with remote interpretation, insurers can increase access to eye care for patients with diabetes. Digital-retinal exams in primary health care settings will serve patients who are not currently receiving an annual exam and who, if needed, can be referred to eye specialists for timely, vision-saving treatment.
Individuals can register their support with congress for bill H.R. 6639, which ensures Medicare beneficiaries with diabetes are regularly evaluated for retinopathy.
Seema Garg, M.D., Ph.D., Retinal Specialist, Associate Professor, University of North Carolina Department of Ophthalmology, [email protected]