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Closing the Diabetic Retinopathy Care Gap: Enhancing Patient Care
There are more than 34 million diabetics in the US and another 7.3 million that may be classified as undiagnosed. Worldwide, there are over 463 million people with diabetes. Diabetic retinopathy affects roughly one-third of diabetic patients, which means there could be as many as 13 million people in the US and 150 million globally who need specialized patient care for diabetic retinopathy.
Early detection can significantly improve patient outcomes, yet a staggering number of diabetic patients fail to undergo routine screenings to detect potential problems.
Optomed’s handheld fundus camera and artificial intelligence-enhanced software can provide an affordable way to significantly increase the number of screenings. By doing screenings at the primary care physician’s (PCP) office, the odds of early detection can increase dramatically.
In this ebook, we demonstrate the advantages of using handheld fundus cameras for screenings at the PCP’s office. First, let’s examine the known factors associated with diabetic retinopathy.
What Is Diabetic Retinopathy?
Diabetic retinopathy develops when high blood sugar levels damage the blood vessels in the retina and is the leading cause of blindness in working-age adults. The disease is asymptomatic in early phases. It requires regular eye screenings for early detection to provide patient care before this debilitating disease progresses.
Screenings are the first line of defense. More than 80% of eye diseases are preventable or treatable if discovered early.
Symptoms, Causes, and Complications of Diabetic Retinopathy
Patients are often unaware of the risk of diabetic retinopathy until their doctor discusses it with them. Even new patients who have gone through a formal education process for diabetes may not be aware of the seriousness of the risk.
The early stages of the disease also often go undiagnosed due to a lack of screening and asymptomatic patients.
Symptoms of Diabetic Retinopathy
Diabetic retinopathy typically affects both eyes and may include any or all of these symptoms:
- Spots or dark strings floating in the vision (floaters)
- Blurred vision
- Fluctuating vision
- Impaired color vision
- Dark or empty areas in your vision
- Vision loss
Some patients may experience these symptoms and assume that they are just a sign of aging. Regular screenings are essential to determine if they are evidence of a more serious condition. Doctors recommend an annual checkup from an eye doctor. If patients are experiencing any of the listed symptoms, however, they are encouraged to get checked right away.
Causes of Diabetic Retinopathy
Over time, excess sugar in the bloodstream can block the small blood vessels that provide nourishment for the retina. When this happens, the blood supply gets shut off. The eyes may attempt to grow new blood vessels, but without a sufficient blood supply, they typically don’t develop and may even leak.
Two types of diabetic retinopathy require patient care:
- Early diabetic retinopathy
- Advanced diabetic retinopathy
Early diabetic retinopathy is the most common form, also called nonproliferative diabetic retinopathy (NPDR). The walls of the blood vessels to the retina weaken. Microaneurysms can develop and leak fluid into the retina. This leakage can cause swelling of the retina (macular edema). Weaker circulation also causes lack of oxygen to the retinal cells, which causes them to slowly die.
Advanced diabetic retinopathy occurs when the body tries to grow new vessels to deliver a blood supply to the retina. These new abnormal vessels can leak blood and fluid into the vitreous central eye cavity, causing a loss of vision.
Scar tissue from the formation of the new vessels can contract and cause the retina to detach from the back of the eye. Glaucoma can also occur if the optic nerve that transports images to the brain becomes damaged.
Complications of Diabetic Retinopathy
Complications can produce serious vision concerns, including the following.
- Vitreous hemorrhage: This occurs when blood vessels leak into the jelly-like substance that fills the eye’s center. This may present first as dark spots or floaters but can progress to fill the vitreous cavity and block vision.
- Retinal detachment: Abnormal blood vessels can stimulate scar tissue. As scar tissue accumulates, it can pull the retina away from the back of the eye. Patients may experience floaters, vision loss, or flashes of light.
- Glaucoma: As new vessels grow, they can interfere with the normal fluid flow from the eye and cause pressure to build up. Pressure is what damages the optic nerve.
- Blindness: Diabetic retinopathy can lead to blindness, especially if it is not caught early.
- Diabetic macular edema (DME): More than half of those suffering from diabetic retinopathy will develop DME. An accumulation of extra fluid into the macula, which often leads to blurred vision.
Without early detection, patients can progress through four stages of diabetic retinopathy.
Stage 1: Mild Nonproliferative Retinopathy
Dilated capillaries, which might appear as red dots, are often one of the first signs. These microaneurysms often don’t affect vision early on and easily go unnoticed without regular screenings. But if it’s detected early, patient care and treatment are most effective at reducing or mitigating the symptoms.
Stage 2: Moderate Nonproliferative Retinopathy
Changes to the retina may become more visible due to a lack of nourishment. An increased likelihood of DME is common in stage-two patients.
Stage 3: Severe Nonproliferative Retinopathy
As more blood vessels are blocked, the retina begins sending signals to the body to grow new pathways to provide nourishment.
Stage 4: Nonproliferative Retinopathy
As the most advanced stage of diabetic retinopathy, blood vessels can begin to grow into the retina. Leaking fluid can lead to severe vision problems and potentially, blindness.
The Keys to Successful Patient Care for Diabetic Retinopathy
Successful patient care for those with diabetes boils down to two specific strategies:
- Early detection
When physicians detect the early warning signs of diabetic retinopathy, referral to a specialist for diagnosis can make a significant difference.
For anyone with diabetes, education is essential in patient care. Patients with type 1 or type 2 diabetes are susceptible to diabetic retinopathy, and the risks increase with time. While type 1 diabetes patients do not typically experience retinopathy for approximately five years after diagnosis, type 2 diabetes patients may already be showing signs at diagnosis.
As patients age, the potential for diabetic retinopathy increases significantly. Studies show that after fifteen years, type 1 diabetics have a 98% chance of suffering some degree of retinal damage. Type 2 diabetic patients have a 78% chance of incurring damage to their eyes.
That’s why regular checkups and early diagnosis are essential for patient care.
Prevention and patient care also required education about the dangers of diabetic retinopathy and recognition of the warning signs that warrant further investigation. Education should include information about high-risk behaviors that can increase a patient’s odds of diabetic retinopathy, including:
○ High blood pressure
○ High cholesterol
○ Unstable blood sugars
Challenges to Patient Care for Diabetic Retinopathy
Even with these sobering statistics, patients don’t always get the screenings they need by primary physicians or eye professionals. When screenings don’t occur, the risk grows significantly.
For example, patients who do not receive diagnostic screening are at four times greater risk than those who get regular screenings.
Primary care doctors do not always have the right tools available to detect the early signs, so there is a lack of exams being done in primary care as well. As many as 60% of diabetic patients do not get retinal exams. Even with warnings, referrals, and proper education, most diabetic patients fail to follow up with eye care professionals to get screenings.
However, accurate and cost-effective screenings for the early detection of diabetic retinopathy are available for PCPs. Advancements in detection technology allow for artificial intelligence-enhanced screenings that can indicate potential problems for diabetic patients, allowing primary physicians to refer patients to specialists for diagnosis.
Rather than hoping diabetic patients will get eye screenings on their own, initial screenings for diabetic retinopathy can happen right in the PCP’s office.
How Optomed Enhances Physician Care
Optomed is a medical technology company and a leading manufacturer of handheld fundus cameras globally. Since the camera can be integrated with artificial intelligence (AI) software, we can enable eye screenings for everyone.
Easy to Use with Minimal Training
Handheld cameras are easy to use and do not require specialized training. In fact, the Optomed cameras require limited training, which makes it a scalable eye screening solution. Studies show that non-ophthalmologist physicians using non-mydriatic retinal cameras have been effective at grading images sufficiently to identify diabetic retinopathy for referrals.
Furthermore, paraprofessional staff with limited training can capture images that are adequate for review by the physician.
Easy to Capture and Store Images
With Optomed’s handheld fundus camera, quality images are captured quickly and easily. They can be shown on connected screens and stored for referrals. This makes it easy to transfer them to your local EMR or patient management software.
The Optomed software and integrated AI are effective at the screening, automatic detection, and identification of potential diabetic retinopathy and other diseases.
Optomed handheld fundus cameras are mobile. There’s no need to ask patients to go to another room or specific screening locations. The high-quality fundus cameras can be used virtually anywhere in any room or moved between physician offices.
Besides mobility and quality, the Optomed fundus cameras for screening purposes are affordable for practices of any size.
Why Doctors Like Optomed Handheld Fundus Cameras for Screening
PCPs can significantly improve patient care when diabetic retinopathy is caught early. Detection gives diabetic patients much better prognoses for any issues that they might encounter.
For physicians, handheld cameras provide several tangible benefits:
- Optomed solutions are cost-efficient and do not require a big investment.
- Doing screenings is a simple way to increase revenue with reimbursement for fundus checkups.
- Because cameras are portable, they can be used in multiple offices, for mobile uses, or even during home visits.
- When warning signs are detected, it’s easy to refer patients to specialists and forward images for review.
Physicians are the new frontline of diabetic retinopathy screening and detection. Patients trust their PCPs and tend to have regular contact with them. By adding routine retinal screenings in the office, PCPs can ensure that patients can get the screenings they need.
This overcomes several of the barriers that prevent patients from getting eye screenings. Because patients are already in the office, they don’t need to make separate appointments or deal with logistical or financial concerns. Since doctors recommend that diabetics see their physician a minimum of four times a year for regular maintenance, reducing the number of additional appointments for patients increases compliance.
Despite physicians urging diabetic patients to pursue eye exams, most do not follow through on exams, which only exacerbates their risk. When exams can happen in the PCP’s office, patient screening rates increase significantly and specialists can catch potential problems earlier.
The use of handheld non-mydriatic fundus cameras is becoming more common. Countries around the world are developing national guidelines or programs for screenings using handheld fundus cameras. For example, an aggressive approach by the United Kingdom on diabetic retinopathy screening had a remarkable impact. Within five years of implementation, diabetic retinopathy was no longer the leading cause of blindness in most adults.
Optomed’s Patented State-of-the-Art Technology
Optomed makes two products that work together for diabetic retinopathy screenings:
- Optomed Aurora
- Avenue Sync
The Optomed Aurora is a handheld fundus camera that has been designed for the highest image quality and ease of use. It has next-level imaging and upgraded intelligent features. For example, the Optomed Aurora features:
- Autofocus and auto-exposure: It automatically adjusts exposure levels for brightness levels to digitally capture images quickly.
- High-contrast optical design: Contrast enhancing filters improve visualization of small early-phase changes and do not require any additional processing.
- 50-degree field of view with non-mydriatic operation: For patients, this means there’s no need for pupil dilation.
- Cloud connectivity: Optomed Aurora can be configured for cloud connectivity to AI software solutions.
Avenue Sync is computer software that runs in conjunction with the Optomed Aurora. This AI-enhanced software can be used to study images further and/or pass them on to a referral system.
Diabetic Retinopathy Treatment
Once a potential problem is detected, PCPs can refer diabetic patients to specialized care providers for formal diagnosis and treatment.
Treatments will vary depending on the severity and progression of the disease. Drugs, such as anti-VEGF injection therapy, can halt blood vessel growth and lower the fluid buildup that occurs in a patient’s retina.
Doctors may also choose to use corticosteroid injections into the eyes, although these can also raise a patient’s risk for glaucoma or cataracts, so careful monitoring of pressure is required.
Other, more invasive treatments may include:
- Vitrectomy: When blood vessels have leaked into the retina and vitreous humor causes cloudy vision, a vitrectomy may be required to remove the leaked blood.
- Macular laser surgery: Lasers are used to “burn” or seal the areas where leaks are occurring in the vessels where sensitive central vision takes place.
- Scatter laser surgery: Thousands of laser burns to the peripheral retina can slow the growth of abnormal blood vessels in ischemic areas of tissue. While this form of laser surgery may be able to save a patient’s sight, they may lose side or nighttime vision and have trouble distinguishing between colors.
Again, early detection is the key. As more than half of people with diabetes will develop DME—and vision loss from DME can’t always be reversed—early detection and proper patient care are essential.
Learn More about Optomed Diabetic Retinopathy Screening
Optomed handheld fundus cameras and software are being used in hospitals, eye clinics, primary healthcare offices, and major medical technology companies. Products are designed to enable widespread access to sight-saving eye screenings and early detection of potential diabetic retinopathy at an affordable price.
If you are interested in more information about Optomed’s line of products to facilitate screenings for retinal diabetes, please contact the experts at Optomed today.Here at Optomed, our mission is to help save the vision of millions of people. By integrating our software and artificial intelligence solutions with our camera, we enable eye screening for everyone, wherever they are. To see how we can equip you to save the sight of more patients, schedule a free consultation today!