While the gold standard for diabetic eye health is for each patient to see an eye care provider for a diabetic retinal exam (DRE), barriers exist that prevent proper eye care for many diabetic patients. The primary barriers for diabetic patients in accessing timely eye care include lack of awareness of needing eye exams, inequitable distribution of eye care providers, and additional costs (in terms of travel, time off from work, and medical fees of seeing another care provider). Screening with a non-mydriatic camera in the primary care setting can overcome these barriers and help to identify patients most at risk for vision-threatening disease. Once you have established the need for remote DR screening in your practice, this manual will help you implement the Tele-I-Care service into your clinic.
A typical visit for a diabetic patient includes several steps. The patient must first check in with the front desk. Then, a nurse will take a patient through Intake, collecting vital signs, height, and weight. After intake, the nurse will lead the patient to wait in the exam room for the physician. The physician will examine the patient, being sure to heed requirements of diabetic patients. The physician reviews the most recent lab values and urinalysis to quantify the patient’s control of his diabetes. The physician must check for ailments common to diabetic patients, paying close attention to signs of peripheral neuropathy and health of the feet.
In addition to these parts of the diabetic visit, the Tele-I-Care service would ensure that the nurse or doctor asks about the diabetic patient’s most recent dilated eye exam. DR screening is indicated for diabetic patients who have:
- Never had an eye exam
- Cannot remember the date of the last eye exam
- Not had an eye exam in over a year.
If DR screening is indicated, the nurse or doctor notifies the clinic’s photographer. Before the photographer sees the patient, certain information must be collected from the patient’s chart. Information includes, most recent HbA1c and most recent blood pressure. After the physician’s exam is complete, the photographer will lead the patient to the designated eye exam room. In that room, the photographer will take the photos and send them to the eye care provider. Finally, the photographer will lead the patient to check out with the front desk.
We maintain a patient tracking surveillance system to ensure follow-up appointments are made and kept. We also use data to create report cards for our clinics to see their metrics.