Expanding Diabetic Retinopathy Screening Beyond the Eye Doctor

There lies hidden potential for expanding retinal screening services beyond traditional eye care settings. Walk-in clinics, urgent care centers, retail clinics, community health clinics, pharmacies, emergency departments, and primary care clinics have opportunities to improve eye disease screening rates. There are various access barriers to eyecare in traditional eye care settings for patients that include limited appointments, long wait times that may interfere with a working day, geographic constraints, and the complexity of vision insurance coverage. Technology has improved the quality and portability of fundus cameras, and AI and telemedicine have improved specialist access. This makes screening attainable by those clinicians in non-ophthalmology settings.

The American Diabetes Association recommends that adults with type 2 diabetes have eye exams at time of diagnosis and within five years of their type 1 diagnosis. Following their initial exams, all patients with diabetes should have annual eye exams. Only about half of these patients receive their recommended annual eye exams. Those that aren’t screened are at high risk for sight-threatening DR, yet many lack knowledge about the disease and the importance of preventive eye care. Early diagnosis and treatment of diabetic retinopathy decrease the risk of severe vision loss by 90%.

“So that’s why I think it’s so important for everybody outside of eye care to really understand how this works and where you can fit in in the screening process and helping your patients. I also think probably the most important point to understand about diabetes and diabetic retinopathy is people can have really bad eye disease and really good vision,” says Dr. Jeffry Gerson OD, FAAO.

“And so, because of that diabetic retinopathy is often a silent thief of vision because people think they’re doing fine, even though they have dramatic disease until suddenly, they’re not. What we know is that with earlier screening and earlier detection, ultimately, we have better outcomes. And these screenings oftentimes really need to be happening outside of an eye doctor’s office, whether it’s in a primary care physician’s office, an endocrinology office, at a health fair, a pharmacy.”

With point of care retinal imaging, we can now help improve these screening rates easier than before. A retinal image can be captured by a technician or staff member with the use of a high quality non-mydriatic fundus camera and can be sent for review by an eye care specialist or an cleared autonomous AI system. This toolset improves on those accessibility challenges and screening rates by coming to where that patient is.

Patients on semaglutide therapy are at a higher risk of nonarteritic anterior ischemic optic neuropathy and initial worsening of diabetic retinopathy. With the proliferation of patients prescribed Ozempic and Wegovy, has your monitoring of your patient’s vision changed? It is recommended for physicians to ensure patients are screened for DR before initiating semaglutide therapy and based on the stage of retinopathy, physicians and retina specialists need to discuss the risk benefit ratio in initiating the treatment. Ensure that your patients are properly screened and keep yourself legally covered by doing the screening yourself.

 

Eye Screening in Any Setting

Patients tend to attend their PCP appointments more frequently than an eye care specialist and could be easily screened at these already scheduled appointments. Patients are more likely to trust their primary care physicians and are more willing to follow their advice. Or consider the amount of time saved by a person going in to get their prescriptions filled and are able to bundle an eye screening visit while they wait. For those persons whose healthcare habits don’t include regular trips to the PCP but occasionally need the services of a retail clinic or urgent care center, they could also be captured with a handheld fundus camera setup. Community health operations and mobile screening clinics

In all these scenarios, the number of persons getting eye screening services has increased and our overall community health has improved. This is exactly what the Centers for Medicare and Medicaid Services and private insurers have incentivized by tying HEDIS measures to improved reimbursement bonuses. For example, the Comprehensive Diabetes Care (CDC) measure evaluates the percentage of patients with diabetes who received essential services, such as HbA1c testing, eye exams, and attention for nephropathy. A high CDC score indicates that a health plan is effectively managing its diabetic population’s care. Health plans collect data from various sources, including claims, medical records, and patient surveys, to calculate their HEDIS scores. These scores are then reported to the NCQA and made publicly available, allowing consumers to compare the quality of care provided by different health plans, as well as gaining enhanced reimbursement rates, performance bonuses, and shared savings / risk arrangements.

Associated CPT codes bring the ability to bill this procedure by non eye-care providers. This new revenue stream is able to diversify service offerings and is a boon to the financial health of the organization. With the same piece of equipment, there are multiple CPT codes associated with the diagnostic procedure, depending on whether the organization is using a reading center, an autonomous AI, or in-house ophthalmologist to interpret the images. As always with medical billing, it is recommended that you consult coding and insurance experts as to the specifics to your geographic area and payors.

92228 Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral
92229 Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral
92250 Fundus photography with interpretation and report

 

Important camera features for eye screening

This non-specialized setting has particular technological needs and considerations from its equipment. The fundus camera should be easy to use, allow non-physicians to obtain high quality images without the need for dilation, and seamlessly send the photos for specialist review. Something as simple and reliable as the Optomed Aurora, which a recent study including multiple sites found that 97% of images taken with the Aurora were of gradable quality.

Space can be at a premium in any clinical setting, which is why a small form factor, handheld device could be beneficial – and the cost savings compared to a bulky desktop machine can’t be ignored. Clinical and real-world studies have shown that the Optomed Aurora is as effective as standard desktop fundus cameras in DR and diabetic maculopathy detection. Unlike most mobile phone-based handhelds, the Aurora IQ meets ISO 10940 standard quality for ophthalmic equipment. It has a field of view that is 5 – 10 times larger than a direct ophthalmoscope and can capture both the optic nerve and macula in a single image.

Whether you’re looking for the traditional comprehensive review of a report from an eye care specialist with the Aurora IQ, or the enhanced efficiency and speed of a fully autonomous system with the Aurora AEYE, Optomed has the solution for you. As Dr. Gerson says, “Not only is this good medicine, but it also makes good financial sense for health care systems.” Improve your organization and your community’s health today.

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