CHCF Expands Project to Prevent Diabetes-Related Blindness Through Telemedicine

Project improves access for patients who face obstacles to care

An innovative project to prevent diabetes-related blindness has proven so successful in California’s Central Valley that it is being expanded across the state, with a goal of serving 100 clinics and 100,000 patients, according to the California HealthCare Foundation (CHCF), the project’s sponsor.

“Diabetes is a major health threat in the Central Valley,” said Veenu Aulakh, M.P.H., CHCF senior program officer. “In addition to some of the highest rates of diabetes in the state, the problem is compounded by high numbers of poor and uninsured patients, a shortage of health providers, and a rural setting that poses transportation obstacles to getting care.”

The Foundation’s Better Chronic Disease Care program area funded a pilot project that uses telemedicine software developed by the University of California Berkeley School of Optometry, expert consultation, digital retinal cameras, and screenings during regular office visits at 13 Central Valley safety-net and rural clinics.

Diabetic retinopathy, which includes hemorrhages and lesions in the eye, is the leading cause of blindness among working-age adults, with 24,000 diabetics becoming legally blind each year in the United States. But with regular screening to identify those most at risk, blindness can often be prevented. “Half of all patients with diabetes don’t get recommended yearly eye exams,” said Jorge Cuadros, O.D., Ph.D., clinical professor of optometry at UC Berkeley. “The statistic is even worse in poor and rural communities.”

Cuadros heads the project, which uses EyePACS, a license-free Web-based software program for capturing and delivering retinal images. The project provides special digital retinal cameras to be used during regular primary care visits at the clinics. The high-resolution retinal photos are transmitted to optometrists and ophthalmologists at UC Berkeley for interpretation, diagnosis, and possible referral to specialists for further treatment. In the two-year pilot period, more than 12,000 patients received screenings, half of whom were diagnosed with some level of retinopathy. Some 15% required referrals (of those, 10% were for sight-threatening retinopathy and 5% were for other eye conditions).

The project has improved access to care and expert consultation, according to Christine Noguera, deputy CEO of Golden Valley Health Centers, whose clinics in Merced and Stanislaus Counties participated in the pilot. In a recent chart audit of patients with diabetes who had received the digital retinal exam, “not a single one had ever had a documented eye exam before their diabetic retinopathy screening,” said Noguera. By folding this service into their primary care visit, “it is absolutely more convenient — there’s no need to go to an unfamiliar facility across town — and the cost to the patient is built into the standard office visit charge, thus eliminating cost as a barrier to care.”

Just as important, Noguera added, clinics are using the retinal images as powerful tools to engage patients in diabetes self-management. “We show patients their own photo, compared with a photo of a healthy eye,” said Noguera. “Diabetes is largely invisible, but this is something tangible that they can see.”

CHCF is funding a $1.8 million expansion of this project and recently selected a group of California safety-net and rural clinics as participants in the first wave of expansion (see list below).

A short video about the diabetic retinopathy project is available through the link below.

Newly Selected Clinic Participants

Alliance for Rural Community Health, Ukiah
Clínica de Salud del Valle de Salinas
Clínica Sierra Vista, Lamont
Clínicas de Salud del Pueblo, Brawley
Clínicas del Camino Real, Inc., Ventura
Community Health Alliance of Pasadena
Community Health Centers of the Central Coast, Nipomo
Community Health Clinic Ole, Napa
Del Norte Clinics, Inc., Yuba City
East Valley Community Health Center, West Covina
Family HealthCare Network, Visalia
Golden Valley Health Centers, Merced
La Clínica de La Raza, Oakland
Northeast Valley Health Corporation, San Fernando
Open Door Community Health Clinic, Arcata
Petaluma Health Center
Queens Care, Los Angeles
Ravenswood Family Health Center, East Palo Alto
Riverside County Department of Public Health
Riverside-San Bernardino County Indian Health
San Francisco Community Clinic Consortium
San Mateo Medical Center
Santa Cruz County Clinics
South Central Family Health Center, Los Angeles
St. John’s Well Child and Family Center, Los Angeles
St. Joseph’s Medical Center, Stockton
T.H.E. Clinic, Los Angeles
Tri-City Health Center, Fremont
University of California, Irvine, Orange
University of California, San Francisco/San Francisco General Hospital

Pilot Project Participants

Darin M. Camarena Health Center, Madera
Castle Family Health Center, Atwater
Chico Family Health, Chico
Communicare Health Center, Davis
Community Diabetes Care Center, Fresno
Family Health Care Network, Visalia
Golden Valley Health Center, Merced and Stanislaus
Golden Valley Health Center, Modesto
Livingston Medical Group, Livingston
Salud Para La Gente, Watsonville
Samaritan Center, Visalia
Tulare County Clinic, Visalia

Contact Information:
Anne Sunderland
Senior Communications Officer, Improving Access

About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.