Telemedicine helps prevent blindness in diabetes patients

0 Comments | Oakland Tribune, Aug 9, 2008 | by Sandy Kleffman

Even though her father lost his eyesight because of diabetes, Maria Ponce went more than two years without an eye exam.

The 44-year-old Pittsburg resident knew she was at risk. She had developed diabetes while pregnant and is now considered pre- diabetic with high blood pressure.

But because she lacks insurance, she decided to forgo her recommended yearly screening.

"It's too expensive to do these type of tests," she said in Spanish, speaking through an interpreter.

That changed last week when Ponce received a low-cost screening at La Clinica de La Raza in Pittsburg as part of a novel telemedicine program now under way at community clinics in the East Bay.

Other Bay Area clinics participating in the program include San Mateo Medical Center and the Tri-City Health Center in Fremont.

The goal is to catch problems in time to prevent blindness.

Using new digital cameras, clinic employees photograph the retinas of their diabetic patients and transmit the images to UC Berkeley or elsewhere for review by off-site optometrists and ophthalmologists.

By having their eyes examined at the clinic, patients can avoid what can be a six-months-or-longer wait to see the limited number of eye specialists who will accept those who are on Medi-Cal or are uninsured.

"For people without coverage, like myself, this is a huge help," Ponce said.

Diabetic retinopathy is the leading cause of blindness among working-age adults in the United States, with nearly 24,000 people losing their sight each year.

It occurs when high blood sugar levels make the walls of small blood vessels weaker and prone to damage. The damaged vessels leak blood and plasma into the retina, causing blurred vision or, in severe cases, blindness.

The best way to prevent retinopathy is to keep blood sugar levels and blood pressure under control. Experts recommend yearly eye exams because, if caught early, further deterioration can be treated with lasers.

"You can avert blindness 90 percent of the time if you get the treatment done in time," said Jorge Cuadros, a professor of optometry at UC Berkeley. "But the problem is, people aren't getting it in time."

Nearly half of all diabetics do not receive the recommended yearly retinal exams, which take a few minutes and are different than the eye-chart tests given to people as they get prescriptions for glasses.

"When a person has diabetes, it's one of the first things that falls by the wayside because they have so many other visits and so many other things to take care of," Cuadros said. "The last thing they think about is their vision because usually they see fine. But the big problem with retinopathy is that you don't know that you have it until it's too late."

Cuadros came up with the idea for the telemedicine program as part of his dissertation while obtaining a doctorate at UC San Francisco. He devised a secure software system that is provided to community clinics free of charge.

The California HealthCare Foundation donated $630,000 to start a pilot program in 2005 in the Central Valley, where low-income rural residents often find it particularly difficult to get to an eye specialist.

Last year, the foundation added $1.8 million to expand the program into the East Bay and other areas throughout the state.

Of the more than 25,000 screenings performed so far at 64 clinics, 8 percent required referrals to an optometrist or ophthalmologist for cataracts, glaucoma and other eye problems, and 8 percent had sight-threatening retinopathy, Cuadros said.

The diabetes clinic at Highland Hospital in Oakland has participated for several years.

"It's a wonderful thing," said Dr. Lyn Berry, who directs the clinic. "They have probably prevented large amounts of blindness in the state of California."

Participating clinics receive a $20,000 retinal camera, and a team of UC Berkeley professors and students train clinic employees to use it.

"It's been a great experience for me," said Laura Martinez, a La Clinica de La Raza medical assistant who has brochures in Spanish to explain the procedure to patients. After she takes the images, she downloads them onto the EyePACS software program. The images become immediately available for review by the off-site eye experts, who usually will report back within a few days.

"I can bring it up and use it as a teaching tool for our patients," said physician's assistant Irene Salceda. She discusses with patients the importance of keeping blood sugar under control, she said.

If a problem is discovered, clinic workers can help the patient quickly visit an eye expert. This helps ensure that Alameda County's overloaded ophthalmology clinic, for example, is put to the best use, Berry said.

In addition to the professors at UC Berkeley who review the images, Cuadros has made arrangements with some community eye experts to examine the photos for particular clinics. They may set aside an hour a day for that.

La Clinica is rotating its camera among several of its East Bay clinics. It will soon go to Vallejo, then to La Clinica's Monument location in three months.