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Affordable Digital Cameras Could Facilitate Eye Exams

Susan Kreimer

In rural states like Iowa, where the nearest ophthalmologist might practicemore than 50 miles away, patients with diabetes often fail to follow throughwith referrals for important routine eyeexams.

Expense, transportation challenges, and inconvenience are just a few of theobstacles that prevent more than half of diabetes patients from receiving theannual retinal exam that helps prevent diabetic retinopathy, says RickKellerman, MD, president-elect of the American Academy of Family Physiciansand a practitioner in Wichita, Kan. Yet evidence shows that, when detectedearly, retinopathy responds well to treatment that may prevent the progressionto blindness.

Aiming to solve the problem, University of Iowa researcher Michael D.Abramoff, MD, PhD, and colleagues are adapting technology that would allowfamily or internal medicine physicians to take digital photographs ofpatients' retinas in about 10 minutes during a regular diabetes checkup.

Currently, a routine eye exam involves dilating the pupils at theophthalmologist's office. Many primary care providers are uncomfortable doingthis because their ophthalmoscope isn't sophisticated enough to identifyabnormalities, Kellerman explains.

An alternative is to use digital cameras that electronically send photos toeye experts who can determine whether retinopathy warning signs are presentand require follow-up care. But current cameras run $30,000–50,000,making them cost-prohibitive for many practices.

Abramoff has received a 4-year, $1.6 million grant from the NationalInstitutes of Health to create a digital camera priced at about $2,000. If theless expensive camera can provide quality images for the same analysis, manymore diabetic patients could receive timely eye exams—before the smallblood vessels in the retina incur permanent damage.

"Almost 10% of patients with diabetes develop diabetic retinopathyevery year," Abramoff says. About 95% contract some degree ofretinopathy within 15 years of diagnosis. "I think this is importantresearch to do," Kellerman says. "The quality-of-care indicatorsfor retinopathy evaluation are just not adequate. Many patients feel thatblindness is the most devastating complication of diabetes," hesays.

Abramoff has teamed with Cindie Wolff, MD, a family physician in Akron,Iowa, to evaluate how well patients accept eye exams in a nonophthalmologysetting that relies on distant expertise. The Wellmark Foundation has provideda 1-year, $30,000 grant for the investigation.

In-Office Eye Testing

The power to perform an exam for diabetic retinopathy already may be withingrasp for many primary care practitioners. Several companies and organizationsmake their retinal photography services available through a variety ofbusiness models.

• EyeTel Imaging, based in Columbia, Md., rents its DigiScope device forabout $4,000 the first year and $1,500 each subsequent year. The system wasdeveloped in partnership with the Wilmer Ophthalmological Institute at JohnsHopkins University in Baltimore, where images are transmitted over theInternet to the EyeTel Reading Center for interpretation.
  www.eyetel-imaging.com.
  
• Inoveon of Oklahoma City, Okla., offers its Diabetic Retinopathy EvaluationService to physicians through a relationship with hospitals using thecompany's 3D imaging iScan software. Trained retinal photographers and readersjudge the outcome in eyesight and reading labs.
  www.inoveon.com.
  
• The Joslin Vision Network (JVN), developed at the Beetham Eye Institute ofthe Joslin Diabetes Center in Boston, uses its Diabetes Eye Care telemedicineprogram to acquire digital retinal images remotely. JVN-certified readersgrade the images for level of diabetic retinopathy and return results withsuggested treatment.
  www.joslin.org/joslin_vision_network.asp.
  
• Vanderbilt University's Ophthalmic Imaging Center in Nashville uses Canon'sEye Q Digital Retinal Imaging System and Bell-South networking technology toenable doctors in outlying clinics to use the service and receive a fullfollow-up care report through the Internet. The service includes stafftraining and ongoing quality assurance from Vanderbilt.
  www.retinopathyscreening.org.
  

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kreimer, S. Search for Related Content PubMed Articles by Kreimer, S. Social Bookmarking                What's this?