Increasing Access to Eye Care
Annual retinal examination of all people with diabetes can help prevent diabetes-related blindness. These exams identify people at high risk for losing their sight and requiring treatment to prevent vision loss. In addition to preserving vision, eye exams and laser treatment of high-risk individuals is very cost effective, saving many health care dollars annually by preventing diabetes-related vision loss. For many people with diabetes, there are no symptoms of eye disease and travel to a specialty eye clinic for a dilated eye exam can be difficult, so some might defer the exam. For this and other reasons only half of American Indians and Alaska Natives (AI/AN) with diabetes obtain the annual retinal examination needed to identify high risk disease and prevent vision loss.
To address this gap in health care, special federal appropriations created the IHS-JVN Teleophthalmology Program in 2000. The program uses innovative telemedicine technology developed at the Joslin Diabetes Center to provide diabetic retinal exams to AI/AN with diabetes. These exams are provided as part of the primary care visit and do not require a separate trip to an eye care specialist.
JVN annual and cumulative imaging volume since inception, 2000 through 2012. Annual and Cumulative volumes increased yearly at a steady rate. Cumulative volumes reached a maximum level of 14,000 and the annual volume reached a maximum of 11,897.
The IHS-JVN Teleophthalmology Program is currently available at over 80 IHS/Tribal/Urban primary care clinics, which allows patients to obtain a diabetic retinal exam during a regularly scheduled medical appointment. Clinic staff captures images of the patient's eyes using a digital camera without the use of dilating eye drops. Special computer software transmits the images to the IHS-JVN National Reading Center located in Phoenix, AZ. IHS eye doctors specially trained by the Joslin Diabetes Center interpret the images and generate a report that is available for the patient's primary care provider. The report includes the level of diabetic retinopathy, presence of any non-diabetic eye disease and recommended treatment or other management.