Diabetic Retinopathy Assessment in the Primary Care Environment: Lessons Learned from 100,000 Patient Encounters

Abstract

A major unresolved challenge in clinical ophthalmology is the elimination of avoidable vision loss due to diabetic retinopathy. Despite well-established guidelines for periodic retinal examinations in patients with diabetes, poor compliance with these recommendations still results in missed opportunities for management of treatable disease in a timely manner. In the past decade, numerous telemedicine diabetic retinopathy assessment programs have been established as a potential alternative strategy to assess patients who would not otherwise undergo a periodic dilated retinal examination. With increasing frequency, these telemedicine diabetic retinopathy surveillance programs are occurring outside of the traditional eye care setting in the primary care or general health arena. Because most patients with diabetes visit their primary care physicians with some regularity, this has been postulated as an ideal environment in which to assess for retinopathy [1]. This chapter describes the approach used by a primary care–based telemedicine diabetic retinopathy assessment program which has been successfully implemented on a wide-scale and long-term basis.