In past blog posts we have discussed the advent and growth of tele-medicine. Routine doctor visits can now be done on someone’s laptop computer, with face-to-face contact with the doctor. Now, a new form of tele-medicine is being developed: tele-retinal imaging technology. This new form of screening is important for those who have diabetes and are at risk of diabetic retinopathy. This condition can develop slowly over a period of years, and often a patient does not seek specialized ophthalmology exams until the damage is already significant and more difficult to treat.

Under the procedure being developed, the doctor uses a special nonmydriatic camera in a primary care clinic, and the ophthalmologist in a remote setting can examine the retinas of the patient. The special cameras make fundus photography far more patient-friendly by eliminating the need for bright lights and dilating drops. In turn, eliminating the 30-minute wait for the pupil to dilate and the time for the eye to adjust following a flash of light speeds the exam. This further benefits the patient and saves time for the practitioner and office staff, an important feature in the managed care environment. This feature also is helpful with glaucoma patients for whom dilation is contraindicated.

Preliminary testing was done at three outpatient clinics serving uninsured and minority populations, and an outpatient pharmacy setting in an urban setting. Retinopathy was identified in about 22% of participants, with most cases being in the earliest stages of the condition. In addition, other ocular findings occurred in about 44% of patients. The need for this kind of primary care exam is greatest in areas where a trip to an ophthalmologist may involve significant travel and in areas where there is a shortage of ophthalmologists and thus long delays in scheduling exams. But it will take time to educate patients about this new procedure. Researchers also found that too many participants who had retinopathy findings did not follow up with the comprehensive care needed to prevent vision loss.

One problem is the lack of infrastructure to manage patients who have worrisome findings. As one researcher said “There is no benefit gained if a patient is detected with [retinopathy] but has no place to turn to have it treated.” As with all new technologies in medicine, there is also a cultural barrier that has to be overcome. Another of the researchers summed it up: “We know that [retinopathy] screening programs can save sight, but what we don’t know is whether these programs can be implemented in a culturally appropriate fashion within the US health system, in a manner where patients would be highly likely to be adherent to follow recommendations for follow-up care.”