The University of Rochester Medical Center’s Flaum Eye Institute has launched a screening program for diabetes-related vision problems in Rochester’s poorest neighborhoods with funding from the Greater Rochester Health Foundation (GRHF), in collaboration with Rochester General Health System (RGHS).
GRHF awarded a three-year, $600,000 grant to support Rochester Area Tele-I-Care, a pilot telemedicine program that links the Flaum Eye Institute, RGHS Department of Ophthalmology and primary care physicians to identify people with diabetes who are at risk of vision loss.
Diabetes is the most pervasive chronic disease worldwide. Without treatment, diabetes can lead to vision loss, poor kidney and heart function, stroke and lower-limb amputations. People with diabetes should see an eye doctor annually to undergo eye exams with dilation, allowing ophthalmologists to monitor patients for diabetic retinopathy, which can quietly lead to blindness if it is undiagnosed or left untreated.
“In our community, 12 percent of the population has diabetes and the rate is double that for African Americans and Hispanics. Because only about six in 10 people with diabetes have dilated eye exams annually, they do not receive the care they need to prevent serious and often irreversible complications,” said John Urban, president and CEO of GRHF. The percentage of underserved patients receiving annual eye exams in the Rochester region is known to be much lower resulting in patients presenting for urgent eye care only after developing severe retinopathy and vision loss.
‘The program increases the ability to screen for diabetic retinopathy in our poorest communities’ by allowing for the visualization and remote examination of the retina during a regularly scheduled primary care visit and reduce the barrier of taking additional time off from work and having to pay for a separate visit to see an eye doctor. It will also identify those patients with vision threatening retinopathy early on to allow for timely vision-saving treatment,” said Rajeev Ramchandran, M.D., a retinal specialist who is leading the Tele-I-Care program.
The pilot program is operating at three RGHS practices starting at Rochester General Medical Associates’ TWIG and Outpatient Department medical clinics and later at Clinton Family Health Clinic. The pilot program gives primary care physicians and staff at these clinics access to portable ophthalmic cameras to capture images of diabetic patients’ retinas. These images are studied for signs of diabetic eye disease by Ramchandran and other ophthalmologists at Flaum Eye Institute. Patients needing further eye care are seen and treated by ophthalmologists at RGH.
“RGHS is pleased to support this important community outreach effort,” said Gwen K. Sterns, M.D., chief of Ophthalmology/RGHS. “Providing screenings and on-going medical and ophthalmologic care for diabetic patients at risk will make a significant improvement in the quality of our patients’ lives.”
The clinic staff were trained to use the specialized camera by expert ophthalmic photographers from Rochester Institute of Technology’s Biomedical Photographic Communications program. Tele-I-Care extends the Medical Center’s and RGHS’ partnership with RIT to provide quality educational experiences for tomorrow’s clinicians and scientists.
"This project provides the opportunity for clinical photographic experience as well as participation in patient outreach,” said Christye P. Sisson, M.S., C.R.A., who leads the Photographic Sciences Program at RIT. “Students can exercise their photographic skills but also teach others how to take photographs – there is no better way to learn than to try and teach someone else.”
Steven E. Feldon, M.D., M.B.A., director of the Flaum Eye Institute, said this effort helps reduce cost of care and increase the number of diabetics who receive regular screening for retinopathy.
“Our clinics have struggled for years to find strategies that increase rates of diabetic retinal screening in our vulnerable patient population. Often the barrier is just getting to the eye doctor or being able to afford to see an eye doctor,” said Beatrice Deshommes, M.D., a physician with Rochester General Medical Associates. “We are at a time when our health system is moving towards centralizing care around the patient in order to eliminate barriers to care. This project offers the possibility to do just that and if successful we will be able to improve clinical quality outcomes while being cost effective.”
The goal is to increase screening rates, from the current 10 percent, to 80 percent for the diabetic population who receive primary health care at each site. Organizers expect to serve about 1,000 patients over three years. The cost of the screenings is approximately $600. Without the screenings it is estimated that 5 percent, or 50 people of those served by the program, would likely experience vision loss or blindness, Feldon said.
“In reviewing the grant proposal, the program committee of GRHF’s board of directors was impressed by the potential to dramatically improve the quality of life for patients with significant cost savings to the community,” said Louis J. Papa, M.D., the committee’s chair.