Diabetic retinopathy is damage to the eye’s retina that is caused as a complication of diabetes. Patients suffering from diabetic retinopathy may not notice initial changes in vision. Therefore, patients with diabetes are encouraged to get a comprehensive dilated eye exam at least once a year.
Jorge Cuadros, OD, PhD, a local optometrist, noticed the need for specialty care and astutely recognized that many times, patients and doctors lack the follow through to ensure that patients receive adequate eye screenings. As a result, in 1994, he developed EyePACS, an open access system that uses digital images (taken with biomicroscopes) and sends to specialists for analysis.
Initially, Dr. Cuadros’ idea was met with constant resistance. Early projects were sabotaged by people who did not believe in the idea or those who felt that it may take away from their own work. However, Dr. Cuadros continued his efforts and through projects with the University of California, Berkeley and trials conducted in China, Dr. Cuadros has been able to successfully push out the idea of telemedicine.
Digital diabetic retinopathy screenings typically take place in medical clinics where patients already frequent. These clinics are equipped with specialized retinal cameras and during a regular diabetes visit, a staff member of the clinic will take a picture of the patient’s retina with a special camera to send the picture to a consultant via a secure website. Shortly after, consultants download the images and reports are generated to deliver reports back to clinics.
As mentioned, all diabetics should undergo a retinopathy screening once each year. Although this screening is intended for diabetic patients, it is beginning to expand to other types of patients as well. Indeed, clinics interested in implementing broader blindness prevention are also using this screening process.
The idea of telemedicine and using digital images as a way to screen for diabetic retinopathy has many exciting implications for both patients and doctors. For physicians, this innovative process allows providers the opportunity to have more interaction with retinal images. Dr. Cuadros has developed a systematic way for providers to use pattern recognition to interpret images and triage patients quickly. Furthermore, there is information in the retina that can not only help with the detection of eye issues, but can also give primary care providers a glimpse into the cardiovascular status of the patient, including information about congestive heart failure, stroke, and other conditions. In addition, this concept makes it easier for primary care providers to collaborate with eye consultants, improving overall patient care.
For patients, this new process can be truly powerful in showing them what is actually happening with their retina when they do not properly manage their diabetes. Indeed, Dr. Cuadros notes several instances of patients who have changed their diabetes management as a result of viewing the digital images. As an added benefit, the process of digital scanning creates a habit of having the images as part of the patient’s medical record, ultimately resulting in more continuity of care for the patient.
Digital diabetic retinopathy screening, which started with one client in Alameda County, eventually spread to the Central Valley, the state of California, and is now present in 6 states as well as 3 countries. Dr. Cuadros’ next step is to continue to grow the concept by expanding the certification process that helps primary care providers better understand the process. Please contact EHI directly if you are a primary care provider interested in learning more about getting involved with EyePACS.