Diabetic Retinopathy: A technological and

innovative intervention

to improve detection of target organ damage

S. Naidu, MD, MPH, FAAFPS. Naidu, MD, MPH, FAAFPMedical Director Medical Director

Oklahoma Community Health Services, Inc.Oklahoma Community Health Services, Inc.Email: snaidu@okchs.orgEmail: snaidu@okchs.org

Payer Mix in Study GroupPayer Mix in Study GroupPayer Mix OCHS Diabetes Registry

Uninsured64%

Medicare12%

Medicaid19%

Commercial5% N=862

Purpose

– Improve screening of patients for diabetic eye disease.

– Evaluate the need for an affordable program to implement retinal screening in diabetic patients.

– Determine and document underlying disease in an unevaluated population.

Methods

Oklahoma Community Health Services (OCHS) has a diabetic population of 862 and is a participant in the National Diabetic Collaborative program. The diabetic population is 64% uninsured and has only 5% covered by commercial insurance.

Measurements

A pre-intervention chart audit was conducted on all diabetic patients within OCHS. Data regarding baseline ophthalmologic evaluations were collected.

Subjects

Every diabetic patient was invited by letter and telephone to participate in the study and undergo retinal imaging. Over a period of one month, 365 patients were enrolled for free iScan screening.

iScan TechnologyiScan Technology

Subjects

The chart audit revealed baseline compliance of 4.5%. The iScan intervention over a period of one month bolstered compliance to 42%.

ResultsResultsLeft Eye

Right EyeNo ME ME not CS MHE CSME CE

No ME 302 2 2 5 8 319

ME not CS 1 1 2

MHE 3 3 1 1 8

CSME 2 2 7 5 16

CE 5 2 13 20

310 5 9 14 27 365

302 patients (83%) had normal retinal scans; 60 (16%) received recommendation for referral to ophthalmology. Of those 60 patients, 8 (13%) were referred for macular hard exudates, 18 (30%) for clinically significant macular exudates; and 34 (57%) for poor image quality or cataracts.

Interpretations

1. Since the cost of the iScan usually represents 30% of the cost for ophthalmologic referral, the intervention resulted in an enormous conservation of financial resources, revealing a large proportion of diabetic patients with normal retinal scans.

2. The intervention dramatically improved diabetic retinal screening in a short period of one month.

3. The need for a cost effective, efficient modality for diabetic retinal screening was dramatically demonstrated.

Conclusions1. Clinics with restricted resources often do not have

affordable programs to screen for diabetic retinopathy, and this program allows for tremendous savings since a large proportion of patients had normal retinal screening.

2. The iScan retinal imaging program is high-quality, convenient, and cost-effective in bringing affordable technology to provide essential screening for diabetic retinopathy, leading to early intervention, improved outcomes, and avoidance of expensive and invasive procedures.

3. Implementation of this cost-effective technology has enhanced the detection of disease and increased the referral rate to ophthalmology for appropriate disease-specific patients. This still resulted in tremendous savings to the system as the retinal screening was already completed.

4. This technology offers a novel approach to develop new policy for retinal screening within the health-care setting. An additional opportunity exists for multiple facilities in close proximity - to cost-share - making this a viable program.