Diabetic retinopathy, a complication of uncontrolled diabetes, is the leading cause of new blindness in working-age American adults. It is characterized by progressive damage to the retina, the light-sensitive tissue at the back of the eye. Early diagnosis and treatment reduces the risk of vision loss; however, half of people with diabetes do not get their eyes regularly examined, or they receive a diagnosis too late for treatment to be effective.
Diabetes is more than twice as likely to occur in American Indians and Alaska Natives (AI/AN) than non-Hispanic whites. Diabetic retinopathy also disproportionately affects the AI/AN population. Many rural reservations are long distances from eye clinics, a circumstance that complicates residents’ ability to obtain annual exams. The researchers are exploring telemedicine, in which digital images of the retina are transmitted to doctors via the Internet, to eliminate the need for patients to travel to eye clinics. Partnering with tribal health programs and an eye care center, the team is comparing the effectiveness of telemedicine with traditional eye exams.
The researchers are recruiting 550 American Indians and Alaska Natives with diabetes at the Hunter Health Clinic in Kansas and the Yellowhawk Tribal Health Center in Oregon. The participants are randomly assigned to a telemedicine group or a traditional exam group. Those in the latter group are referred to local eye care providers, who conduct a traditional exam. During a traditional exam, eye doctors administer eye drops to enlarge (dilate) the pupil so they can examine the retina; many people find dilation objectionable. The telemedicine group participants will have their retinas imaged at a tribal health clinic by research assistants using a nonmydriatic camera, which uses special lenses and infrared light to take images of the retina through undilated pupils. The images are stored and later sent via the Internet to the Devers Eye Institute in Portland, Oregon, where eye doctors review them. Participants requiring follow-up care are referred to their eye-care provider.
The researchers will follow each participant to determine which diagnostic approach is more effective at detecting diabetic retinopathy. The center also will compare the two methods’ cost-effectiveness, including the costs incurred by the patient (such as lost wages during the time it takes to drive to and see an eye doctor), the health care provider (including equipment and the cost of a room for a telemedicine clinic), and third-party payers (insurance companies or the government). In addition, the researchers will administer a survey to determine the factors that affect adherence with annual eye exams.