January 11, 2013

Drs. Sinclair and Stansbury are helping West Virginians in rural areas gain access to eye screenings.Living with diabetes involves more than just proper nutrition and exercise—the disease puts those who have it at risk for several other serious medical conditions, such as blindness. That's why it's so important for people living with diabetes to have annual eye screenings to check for any changes in the retina or optic nerve.

Unfortunately, many West Virginians living with diabetes don't have access to these screenings, but the CAMC Institute Center for Telemedicine is changing that with help from WV Eye Consultants. The CAMC Institute received a grant in 2010 from Frontier Communications, which, combined with CAMC Institute monies, allowed them to fund the portable digital retinal cameras and other necessary equipment to rural communities currently without the resources to screen for diabetic retinopathy.

In West Virginia, diabetic retinopathy (damage to the eye's retina caused by Type 1 or Type 2 diabetes) is the leading cause of blindness, and there are few warning signs for early detection. Research has shown that a retinal photograph, even without a dilated eye, can show the early stages or diabetic retinopathy.

"We can find disease that would otherwise go unnoticed," said Christopher Stansbury, OD.

Rural health centers with existing telemedicine equipment can apply for mini-grants through the CAMC Institute to receive the retinal screening equipment. The clinics participating in the program conduct the screenings in the office, and the films are sent electronically to WV Eye Consultants in Charleston for ophthalmologist Joseph Jefferds Sinclair, MD, and Stansbury, an optometrist, to review.

Currently, the program has one satellite office operating at Community Care WV in Clay (opened in early June), but Barbara McKee, RN, an outreach coordinator for the Center for Telemedicine, hopes to get equipment to more rural areas soon.

"Our goal is to equip a total of six rural locations with the retinal cameras, which will hopefully increase the number of diabetic patients receiving the screenings," McKee said.

When patients come to Community Care WV for a regular check-up or other appointment, Sarah Chouinard, MD, medical director, offers the eye screening as a regular part of the visit. Chouinard said patients often don't see the value of diabetic retinopathy screening because in most cases it's asymptomatic.

"Traveling to a doctor's office for something they don't see value in is something that's hard to push. What's so great about this is with the setup right in the office, we make it quick and convenient for them," Chouinard said. "It's been a game-changer for us. The patients don't have an excuse not to get screened."

Once Chouinard's office staff takes the images, Sinclair and Stansbury can essentially video chat with the patients and discuss the results of the scans and any subsequent treatment plans.

"It's a huge opportunity to provide a level of care that isn't currently available," Sinclair said.

Chouinard is thrilled to be able to offer the service to her patients, and is grateful to the CAMC Institute and WV Eye Consultants for making it happen.

"So many projects are routed in a financial gain...this is all about patient care," Chouinard said.

If a patient has signs of diabetic retinopathy, the doctors recommend he or she get a more thorough, dilated eye exam, and offer to see the patient themselves if he or she isn't already established with an eye doctor. For more severe cases, the patient might be referred to a retina specialist. Treatment could include injections or laser surgery, and in extreme cases, more invasive surgery.

"We have the potential to prevent a whole lot of diabetic eye disease by creating value for patients by catering to them. I'm excited about it because it's a service we should offer, and we've never been able to until now," Chouinard said.

A large part of preventing diabetic retinopathy is keeping blood sugar levels under control, so patient education plays a major role in the telemedicine program. The eye is one of the first places that diabetes is visible.

"Sometimes we diagnose diabetes," Sinclair said of his practice.

So far, Sinclair and Stansbury have seen 20 patients through the telemedicine program, and are eager to get the other clinics up and running.

At last year's CAMC HealthFest, 42 people were screened using the portable retina cameras.

CAMC Institute is currently going through applications for the mini-grants and is hoping to have all six sites up within the next year. The diabetic retinopathy program is the third telemedicine program for CAMC. The Center for Telemedicine also manages programs in perinatal health and psychiatry.

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