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Telemedicine May Enhance Screenings for Diabetes Vision Issues

Access to convenient telemedicine services like remote eye exams could improve patient screening for diabetic retinopathy, the leading cause of new-onset blindness in the US.

By Nathan Boroyan

- Telemedicine could become an important tool for screening patients for diabetes-related blindness, according to a University of Michigan study.

Telemedicine and diabetes eye care

Diabetic retinopathy is the main cause of new-onset blindness in the US. However, only 65 percent of adult diabetics in the country undergo screening for the condition. Access to telemedicine services like remote eye exams could improve patient screening for diabetic retinopathy, the study found.

“Telemedicine has been shown to be a safe method to provide monitoring for diabetic eye care," says Maria Woodward, M.D., senior study author and assistant professor of ophthalmology at the Kellogg Eye Center. "If physicians plan to change the way that people get care, we must create a service that is appealing and tailored to the patients."

Researchers at UM's Kellogg Eye Center surveyed 97 adults with diabetes mellitus. Overall, results of the survey showed a willingness among patients to participate in telemedicine.

Patients who said they valued the patient-physician relationship or have had diabetes for a longer period of time were less willing to utilize telemedicine services. But patients who perceived telemedicine as a more convenient option were more willing to utilize the services.

"It is critical to understand the attitudes of people with DM where telemedicine shows promise for disease management and end-organ damage prevention," the authors of the study wrote. "Telemedicine monitoring should be designed for people who are in need and receptive to telemedicine."

Telemedicine offers primary care providers the opportunity to play a larger role in preventative care for diabetics. For example, patients with diabetes could take a digital eye exam at the doctor's office and have the images sent securely online to an eye care provider for evaluation. Based on a report from the eye care provider, the physician would either recommend additional imaging or refer the patient to an ophthalmologist.

A potential hurdle for telemedicine initiatives may be a lack of knowledge among patients. According to the UM study, only three percent of the 97 diabetics surveyed had heard of telemedicine. After telemedicine was explained, 69 percent of believed it could be more convenient than a seeing a specialist for a one-on-one exam.

Two of the main benefits of telemedicine are increased access to services for underserved or more remote populations and reduced cost for patients. A program developed by the Barbara Davis Center for Diabetes (BDC) at the University of Colorado Anschutz Medical Campus, which allows Type 1 diabetics to complete appointments and communicate with their doctor in real-time remotely, demonstrates telemedicine's ability to provide both.

Digital health platforms could play a major role in the early detection of chronic conditions by providing patients with more convenient access to resources like digital eye exams, or by fostering patient-provider communication. More access to services and increased engagement could allow providers to diagnose and treat people with a condition like diabetes before symptoms become noticeable.

For example, a health system in Minnesota is using a telehealth platform to offer an online questionnaire to iOS and Android mobile device users that calculates a patient's risk of developing diabetes or heart disease. If a patient is found to be at risk, he or she is instantly referred to a nearby lab for diagnostic testing. Within 48 hours, the test results and the questionnaire will be reviewed by a provider who will provide a recommendation and additional educational resources via email.

With the number of diabetics worldwide projected to more than double by 2030 to 366 million, the need to develop and utilize more innovative tools to improve screening is paramount to early detection and chronic disease management. While telemedicine could be an effective way to prevent blindness from diabetic retinopathy, understanding how to tailor services to fit patients' needs and providing education on the benefits of telemedicine is paramount to success.

“Patients with long-standing disease are less likely to trust a new, less-personal delivery model," says Woodward. "In our study, the highest impact on willingness was convenience of telemedicine. Our results indicate that willingness to participate in telemedicine for diabetic retinopathy screening reflects how patients perceived convenience, the patient-physician relationship and their own health.”

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