Telemedicine is enabling ophthalmologists from Legacy Good Samaritan Devers Eye Institute to treat Native Americans hundreds of miles away in Pendleton, Ore., and Wichita, Kan. The hope is that the program, which is being run in collaboration with researchers at Oregon Health & Science University, will serve as a model for how to reach underserved patients before diabetes robs them of their sight.
Diabetic retinopathy is a leading cause of blindness in working-age adults. It is a complication of diabetes that results from damage to the blood vessels in the retina, the light-sensitive tissue at the back of the eye.
The cornerstone of prevention of vision loss is annual eye exams and early treatment, but less than 50 percent of Native American diabetic patients receive annual eye exams. Only two of the 43 federally recognized tribes in the Pacific Northwest have affiliated clinicians who can provide yearly eye exams. The long distances between many rural reservations and urban eye-care centers complicate routine care.
“Diabetic retinopathy is common in American Indians, but the tribes struggle with access to eye exams,” says Steve Mansberger, M.D., Legacy Devers Eye Institute. “Telemedicine has a large potential public health impact if we are able to document even a small increase in the proportion of eye exams.”
OHSU’s Center for Healthy Communities, a Prevention Research Center funded by the federal Centers for Disease Control and Prevention (CDC), for the past six years has lead collaboration with the Legacy Devers Eye Institute and the Northwest Portland Area Indian Health Board. Together the institutions initiated vision screening and eye exams in multiple tribal communities, establishing, among other things, a high prevalence of patients with undiagnosed glaucoma as well as diabetic retinopathy. Telemedicine is one component of this research program. OHSU’s Center for Healthy Communities funded Legacy Devers Eye Institute’s development of a HIPAA-compliant, secure, store-and-forward web-based telemedicine system that uses non-mydriatic cameras to capture images of the retina and optic disc. Community-based research assistants in Pendleton and Wichita photograph diabetic patients’ eyes and transmit the images electronically to Legacy Devers Eye Institute in Portland for reading and diagnosis. OHSU researchers serve as the administrative hub for the project, providing data analysis and evaluating the program to measure its efficiency and long-term sustainability.
“Through this program, OHSU is expanding knowledge of a promising method of telemedicine which will benefit the larger medical community involved in vision care and the management of consequences for diabetics,” said William Lambert, Ph.D., associate director of OHSU’s Center for Healthy Communities. “It’s an innovative approach that makes it possible for patients in rural communities to gain access to experts for a diagnosis and treatment recommendations.”
OHSU’s involvement made it possible for the program to win a $2 million grant from the Centers for Disease Control and Prevention because OHSU is a member of the CDC’s Prevention Research Center Program. The funds will be used for a study to determine the effectiveness of telemedicine in detecting the progression of diabetic retinopathy compared with traditional annual eye exams in an eye-care provider’s office. Other goals of the project are to:
• Develop and refine the Compliance with Annual Diabetic Eye Exams Survey (CADEES) to determine the factors related to adherence with annual eye exams using telemedicine and traditional surveillance methods.
• Estimate the cost-effectiveness of a telemedicine system from the perspective of both provider (health care system) and the individual patient.
The data from this project will be presented to legislators to provide the framework for changes in national and statewide guidelines in addition to insurance reimbursement for diabetic eye exams.
Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government). OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.