By the time someone living with diabetes starts to see spots or blurriness, their eyes may have already suffered irreversible damage.
The best way to prevent vision loss and blindness is to receive treatment before symptoms start.
“If the patient waits too long, we can still help them, but we can’t get them back to 20/20,” said Dr. Igor Westra, an ophthalmologist with Retina of Coastal Carolina.
Dr. Westra said 60 percent of diabetics do not get annual eye exams that can catch diabetic retinopathy, the most common diabetic eye disease and a leading cause of blindness. High glucose levels can eat away at the walls of the blood vessels in the eye, causing them to leak. Just as poor circulation can harm the feet and legs in diabetics, affected blood vessels in the eye can damage the retina, tissue at the back of the eye that detects light.
Diabetic retinopathy affected 7.7 million Americans in 2010, a number that is projected to increase to 14.6 million by 2050.
An innovative program at NHRMC Physician Group is helping to identify the disease before symptoms start.
In February 2017, five primary care locations started offering diabetic retinal imaging. Those locations held the largest diabetic patient population in the system and were projected to make the biggest impact.
When a diabetic patient comes to the office without a recent retinal eye exam on file, the electronic medical record will alert the primary care physician, who can order an in-office retinal imaging test that takes only minutes while the patient is already there.
While the retinal imaging tests do not replace an annual eye exam, the images can help identify the need for further treatment in diabetic patients who have not had an eye exam. Some of those patients were previously referred to an ophthalmologist, but didn’t make an appointment.
“This program is really good because it’s right there where all the diabetics are,” said Dr. Westra, whose practice reviews the images.
Within the first year, staff at NHRMC Physician Group offices completed 1,194 retinal imaging exams, reaching 25 percent of the diabetic population in primary care.
Eye disease was identified in 10 percent of those exams, with diabetic retinopathy marking the leading disease, though glaucoma was also identified in some patients.
This successful program resulted from out-of-the-box thinking, said Kim Hood, the radiology manager for NHRMC Physician Group. Instead of hiring an outside vendor that would perform the tests, the practices used existing radiology and nursing staff.
“Our ultimate goal was to identify issues early, help patients receive appropriate treatment from an eye care professional, and prevent blindness associated with diabetes,” Hood said. “We are pleased this project could make the imaging process convenient for patients and identify the timely need for follow-up treatment.”
Hood will join Marian Proctor, the physician group’s manager of care coordination, next month in Orlando, where they will present the results of the project at the annual meeting of the Association for Medical Imaging Management.
The effort earned a 2018 Gold Touchstone Award from Atrium Health, which is affiliated with NHRMC. The awards recognize projects that achieve the greatest level of improvement and demonstrate a best practice in patient safety, clinical outcomes, clinical efficiency and patient experience.