A Diabetic Retinal Exam (DRE) allows us to screen for Diabetic Retinopathy—the leading cause of blindness in adults today. Diabetic retinopathy develops when elevated blood sugar levels damage blood vessels in the retina. Patients who have had diabetes for at least ten years have a 50% chance of developing DR and a 90% chance after 30 years. For most diabetics in the United States, it’s not a matter of “if” they get this disease, but “when.”
The American Diabetes Association recommends that all people with diabetes have a DRE screening once a year. However, currently, only 30% to 40% are getting it done. That leaves a vast majority of the diabetic population with the possible disease who will benefit from access to a DRE program at their Primary Care Provider’s office.
IRIS’s mission is to end preventable blindness, and we want to give health organizations across the country the tools needed to join that mission. With an effective program and workflow for early detection and intervention, you can significantly impact your patients’ lives.
Here are three tools that every clinic striving to implement a successful DRE program needs to have in place:
1. Clinic Leadership Support
All successful and sustainable healthcare initiatives begin with leadership support. This top-down approach is no exception for DRE programs. Site-level leaders, including physician champions, providers, and clinic managers, should be the decisionmakers and the motivating drivers of an effective DRE program.
They provide the workflow plan and support, approve the necessary staffing, and set the program goals while monitoring the results with accountability. Engaged leaders ensure that the DRE program is financially viable and that it ultimately improves the clinic’s patient population.
These same leaders are the drivers of a clinic’s culture, responsible for keeping the clinic focused on the goals that are put into place, updating the team on their progress, and holding them accountable for results. Supportive leaders should aim to instill a sense of ownership of their DRE program and their camera operators, who are ultimately responsible for making everything happen.
2. Effective Camera Operators
Using a boat analogy, if supportive leaders at the site-level represent the steering wheel and engine fuel of a successful DRE program, then knowledgeable and confident camera operators represent the boat’s hull and motor. These competent camera operators (or Super Users, as we call them at IRIS) keep the program moving and are the key to creating an exceptional overall patient experience.
Ideally, each clinic should have 2 to 3 Super Users, depending on the clinic’s size and staffing. The Super Users must be knowledgeable about the clinic’s DRE operational workflow and be confident about using the retinal camera and equipment.
As the primary camera operators and subject matter experts of the clinic’s program, Super Users are responsible for educating and training new staff members whenever there is turnover.
Patient communication and interaction is a significant part of the DRE experience. The Super Users should intelligently communicate the exam’s process and emphasize its importance to the patients at their visits.
3. Pupil Dilation
A successful retinal exam is dependent on the quality of the images collected at the site level that are later interpreted by an eye specialist. And the key to capturing quality images is the size of the patient’s pupils.
A larger pupil will enable the flash to illuminate the retina for the picture entirely. Likewise, a small pupil prevents the flash from reaching the retina. For most patients, sitting in the dark for 5 to 10 minutes allows plenty of time for the pupils to enlarge, or dilate. However, some elderly patients may need to sit in the dark a bit longer to dilate, or at specific organizations that allow it, may need the assistance of dilation drops to open the pupils.
0.5% Tropicamide drops can be used for patients whose pupils will not dilate naturally. This solution strength is the weakest available dilating drop available, requires 10 to 15 minutes to take effect, and still allows patients to drive directly after use[a1].
Diabetes affects many areas of the body and can cause severe eye disease, including glaucoma, cataracts, and diabetic retinopathy, all of which, if left untreated, can lead to blindness. The American Diabetes Association (ADA) recommends diabetic patients have an eye exam each year.
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