Eastern Plumas Health Care’s Telemedicine Diabetes Retinopathy screening offers an essential aspect of care for diabetics. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina, which is the light-sensitive tissue at the back of the eye. In diabetics, the blood vessels may swell and leak fluid. In the late stage proliferative form, abnormal new vessels may grow and cover the retina. These can leak and cause blurred vision or blindness.
Diabetic retinopathy is treatable when it is caught in time. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care—which is why this screening is absolutely essential for diabetic patients.
What makes EPHC’s screening even more vital is the fact that it offers the only diabetic eye care screening available to Medi-Cal patients in all of Plumas and Sierra Counties. There is no eye doctor in the county that takes Medi-Cal at this time. Dr. Michelle Kim stressed that the screening does not take place of a full vision screen, but it’s an important way to identify diabetic patients who are at risk for vision loss. Because EPHC is the only provider in the county to take Medi-Cal insured patients, this offers them an essential first step. Those who need follow up care, will be referred out—likely to UC Davis, according to Dr. Kim.
Patients who come in for the diabetic retinopathy screening will be seen by FNP Mary Morrison, who has been trained to administer the test. She’ll first determine if there is any risk to the patient from dilating the eyes, as patients who have glaucoma can experience damage from the pressure caused by dilation. Once she determines there’s no risk, she’ll administer the eye drops to dilate the eyes before photos of the retina are taken. At risk patients can have an exam without dilation, it is just slightly more difficult to read.
Telemedicine Coordinator, Silvia Jawwad, who has been trained in use of the retinopathy camera, will take the photos with Morrison in attendance. The photos are sent digitally to top Opthamologists at UC Berkeley who read them and send the results back to EPHC. If follow up care is deemed necessary, patients will receive a referral, and, if they have Medi-Cal they’ll need to get their follow up care with a quality provider that accepts their insurance.
Morrison will also ask patients basic questions that will be included in their personal record. These include the date of their last lab tests for A1c, microalbumin, and lipids. They’ll also be asked if they’re taking statin or aspirin, the date of their last eye and foot exam, and whether they’ve had any telemedicine diabetic education and medication management training, among other things. Morrison will order necessary labs and refer patients back to their primary care providers for any additional follow up.
EPHC plans to begin calling diabetic patients this week to explain the retinopathy screening and schedule them for appointments. According to Dr. Kim, “This is a recipe to follow—to remind patients what care they need when and support their care. We plan to work proactively with patients by creating this online database, which we’ll monitor to make sure patients get all the elements of care they need.”
The hope is that newly diagnosed diabetic patients will be “fast tracked for telemedicine diabetic education,” so that they get started right. A care coordinator will monitor the online database and will keep patients on track by calling to remind them when they need lab work, screenings, and other care.
“It’s astounding that we have this [retinopathy camera]. We need to get the word out,” Director of Nursing, Linda Jameson, herself a diabetic, said adding that, “it’s truly a challenge to track patients and proactively monitor their care, but it will be so remarkable to see it happen. Even my own endocrinologist in Reno doesn’t track me.”
Dr. Kim acknowledged, again, that many patients are hesitant to try telemedicine, but that after the first visit, they’re very positive about the experience. Patient Jimmy Encinas agreed wholeheartedly. When his provider suggested that he have a telemedicine retinopathy screening, he said he “was surprised and didn’t know what he was getting into.” When he learned that he could get the eye exam he needed right here in Portola rather than travel a long distance, he decided to give it a try. “It’s a great program,” he said. “A lot of diabetics here are retired, and financially it’s not easy to travel for care.”
Of the retinopathy screening, Encinas said, “The telemedicine they give us—it’s gorgeous. I love it. We really need this machine!”
According to EPHC’s Portola Clinic Medical Director, Dr. Michelle Kim,” Diabetes is a complex medical disease which has the potential to cause damage to many different organs in the body including the heart, kidneys, and eyes. During the course of their visit, Mary Morrison will work closely with the patients’ primary care provider to ensure patients are up to date on routine tests and are taking the necessary medications, which have been shown to prevent these long term complications. With today’s technologies, our primary care clinics are armed with the necessary tools to help prevent the long term complications of this disease. Please contact any of our primary care clinics if you would like additiona information or to set up a visit to review your diabetes care and management with any of our primary care providers.”