Large-scale screenings for diabetic retinopathy boost exam rates, reduce wait times
UCLA researchers found that offering an eye exam for people with diabetes in a primary care setting in addition to eye clinics — where the exam is usually performed — dramatically reduced the length of time people had to wait for the exam and increased the number of people who underwent screenings.
The exam, teleretinal diabetic retinopathy screening, identifies people at risk for a disorder called diabetic retinopathy, which affects more than 5.3 million people in the U.S. and can cause blindness if untreated. Among those who were screened, wait times for the exam decreased to 17 days from 158 before the program began, and screening rates increased to 56.9 percent, from 40.6 percent. Of 21,222 patients, 68.8 percent did not require referral to an eye care provider, 19.6 percent were referred for treatment or monitoring of diabetic retinopathy, and 11.6 percent were referred for other ophthalmologic conditions.
Although early detection and treatment can prevent the disease from causing blindness, diabetic retinopathy is the leading cause of blindness among working-age adults. In Los Angeles County, Latinos are the majority users of health clinics that serve lower-income, uninsured people and Medicaid recipient — and among Los Angeles Latinos who have diabetes, approximately 50 percent have diabetic retinopathy. But the wait for screenings at eye clinics is often eight months or more thanks in part to limited specialty care resources. Only 60 percent of Americans with diabetes receive recommended annual eye examinations, and in at-risk populations, screening rates have been as low as 25 percent or less.
The screening has traditionally been performed by dilating patients’ eyes at ophthalmologists’ offices. But the screening can also be done using retinal photography at primary care clinics.
The UCLA researchers implemented teleretinal diabetic retinopathy screening programs in 15 of the largest primary care clinics operated by the Los Angeles County Department of Health Services and evaluated results at five of the clinics. The screenings took place between September 2013 and December 2015.
Teleretinal diabetic retinopathy screening programs could help maximize access to much-needed eye exams for largely underserved segments of the population.
The paper’s senior author is Carol Mangione, who holds UCLA’s Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine. Lauren Daskivich of the Los Angeles County Department of Health Services is the lead author. Other authors are Carolina Vasquez and Chi-hong Tseng of UCLA, and Carlos Martinez Jr. of Charles R. Drew University of Medicine and Science.
The study was published in JAMA Internal Medicine.
The research was supported by the UCLA Robert Wood Johnson Foundation Clinical Scholars Program, the UCLA Resource Center for Minority Aging, the National Institutes of Health/National Institute on Aging (grant P30AG021684), the NIH National Center for Advancing Translational Science UCLA CTSI (grant UL1TR001881).