A Vital Sign


By Sunil Gupta, MD

Primary care physicians are the frontline defense against diabetes. They are responsible for managing everything from a diabetic patient’s weight, their cardiovascular health, and now their eye health.  

One of several key quality metrics that healthcare organizations are held accountable for is the completion of an annual diabetic retinal exam (DRE) for every documented patient with diabetes. Typically, primary care physicians do not perform diabetic retinopathy (DR) exams, but rather refer patients to eye care specialists for the testing.

As there are many physician visits required for those with diabetes, many patients simply don’t go to the eye care specialist as referred. Research has found that over 60% of patients skip these potentially sight-saving exams. What makes that number even more staggering is the fact that between 40 and 45% of Americans diagnosed with diabetes have some stage of DR, and half of that number are unaware of their disease.

If primary care physicians embrace in-office retinal imaging technology to screen patients with diabetes for vision issues, not only can they improve the standard of care and alert patients early about their potential disease, but also guarantee they achieve managed care quality measures associated with annual DR exams. Typically, what’s not measured is not managed.

A number of potential barriers can prevent people with diabetes from obtaining DR exams—including insurance, misunderstanding the exam’s purpose, lack of access to an eye care provider, and general hardships related to an appointment; such as transportation and time off work. 

Virtually all of these difficulties are eliminated by bringing retinal imaging into the primary care setting.

“Patients really enjoy having the convenience of being able to see their physician and have an eye exam at the same time all in one location,” says James Bonucchi, DO, ECNU, FACE, an endocrine consultant at Missouri-based CoxHealth, which implemented the technology in 2016. “It is saving our patients time away from work by being able to have a screening exam in the office.”

The process used to capture images, which are then uploaded into the IRIS cloud-based system, is straightforward allowing nearly any clinical or administrative employee to perform a DR exam after a short training period. Capturing an image of both eyes typically takes fewer than five minutes and most of the time doesn’t require patients’ eyes to be dilated.

Primary care offices are busy – they have full workloads and adding one more thing to their day is far from ideal. While offering the DRE to patients is another item on the to-do list, it can be as quick and simple as a vital sign. It is vital that patients receive this exam early enough to save their sight. The more the physicians and health systems offer comprehensive care, the more impact we will have on down-the-line healthcare costs, as well as  better performance on the metrics they are held accountable for in-house. Win, win, win.

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