Diabetic Retinopathy Screening
June 2010
Project Background
An innovative pilot project to prevent diabetes-related blindness in California's Central Valley has had such positive outcomes that it is being expanded across California, with a goal of serving 100 clinics and 100,000 patients.
Diabetic retinopathy is the leading cause of blindness among working-age adults: 24,000 diabetics become legally blind each year in the United States. Clinical trials have demonstrated that early detection and treatment of diabetic retinopathy can reduce vision loss by 90%. Quality care standards dictate that people with diabetes receive an annual eye exam to screen for diabetic retinopathy.
The rural areas of California are some of the hardest hit by diabetes. Addressing diabetes in remote regions is complicated by high rates of poor and uninsured people, high numbers of diabetic patients with no regular source of care, relative shortages of health personnel, and a widespread setting that poses transportation obstacles.
Because of CHCF's emphasis on improving chronic disease care and its commitment to developing low-cost models to improve access to specialists, CHCF funded a pilot project to implement remote diabetic retinopathy screening in the Central Valley. The initiative used EyePACS, a license-free Web-based software program for capturing and delivering retinal images that was developed by the University of California Berkeley School of Optometry.
An evaluation of the pilot project in 12 community and county clinics showed a significant impact. Over the two-year grant period, the EyePACS system was used to screen over 12,000 patients, half of whom were diagnosed with some level of retinopathy. Only 15% of the cases, however, were advanced enough to require referrals (10% for sight-threatening retinopathy and 5% for other eye conditions). In addition to the Central Valley clinics, EyePACS has been used by 25 other safety-net organizations in California and Mexico.
In the fall of 2007, CHCF funded a $1.8 million expansion of this project to supply other areas of the state with digital retinal cameras, telemedicine software, and/or expert consultation. Following a request for applications, more than 35 additional clinics and centers were selected and have implemented diabetic retinopathy screening.
New Funding Cycle for 2010
CHCF has issued an additional request for applications from new clinics with a high volume of diabetes patients to implement retinopathy screening. Clinics should have an interest in:
- Integrating retinopathy screening services into primary care;
- Having access to a no-cost retinal camera system (valued at $24,000);
- Receiving training of staff for retinal photography;
- Establishing an on-site screening program, with access to EyePACS retinal care software;
- Participation in a learning community focused on to improving clinic screening programs; and
- Receiving diabetic retinopathy screening reading services and reports by eye care professionals.
UC Berkeley will offer reading services at a low cost of $15 per screen for participating clinic organizations. Priority for program participation will be given to clinics with large diabetic patient populations (able to screen 700 to 1,000 patients per year) and those utilizing UC Berkeley's reading services. The program will provide cameras and technical assistance, including the EyePACS software, and a learning community for clinics who meet the criteria above.
Applications are being accepted on a rolling basis beginning in June and continuing through October 2010, subject to funding availability. See the complete request for applications and the application form under Related CHCF Pages.
To hear more about the beneficial impact of diabetic retinopathy screening for patients, providers, and specialists, watch the video (6:25 minutes) and see the links below.
Cost-Effectiveness of Store and Forward Technology
The store and forward teleophthalmology screening method has the potential both to reduce costs and to improve access to health care services. According to an analysis by Blue Sky Consulting Group for the California HealthCare Foundation, for each patient examined for retinopathy with store and forward telemedicine, state cost savings will total nearly $2,500 over the patient's lifetime. Read the complete report, Fiscal Impact of AB 175: Analysis of the Cost Effectiveness of Store and Forward Teleophthamology, on Blue Sky's site through the External Link below.