Prevent Blindness Through a Tele-retina Screening Program
Diabetes Canada recommends that all people living with diabetes have a special eye exam by an ophthalmologist or optometrist every 1-2 years. Despite this recommendation, only 60% of people living with diabetes have a regular eye examination, resulting in thousands of Canadians suffering the loss of sight – a most feared complication of diabetes.
Early detection of DR, by a regular screening of the retina, is an effective method of avoiding vision loss from diabetes. There are effective therapies that can prevent visual loss and slow the progression of the damage if detected early. Therefore, it is critical to screen all people living with diabetes for early or more advanced diabetic retinopathy.
Younger adults with type-1 diabetes, Indigenous peoples, recent immigrants and residents of inner cities and remote areas have lower screening rates. Unfortunately, we know that many people living with diabetes do not have access to regular eye examinations. For those individuals, an eye exam can be performed using a mobile imaging system – telemedicine – Tele Retina. The retina images are uploaded on a server; retina specialists can access them remotely to grade the level of retinopathy and provide a report back to primary care provider with management recommendations. Currently, more than 500 DR Tele Retina screening sites, serving both inner cities and remote areas, are operating in Ontario, Quebec, British Columbia, Alberta and Manitoba, with the majority of sites in Western Canada. However, programs across the Provinces are not created equally and accessibility to retinal screening continues to be an issue.
At Diabetes Action Canada, we endeavour to develop a national DR screening program to prevent diabetes-related visual disability, blindness and to address the barriers to the screening access to all Canadians with diabetes. Our group is implementing a best practices approach with high potential to scale-up to other regions, for the early diagnosis and management of DR.
In Ontario, in partnership with Ontario Telehealth Network (OTN), Diabetes Action Canada plans to work with each Local Health Integration Networks (LHINs) to develop a customized and sustainable program that can integrate into existing regional chronic disease management program through Community Health Centres (CHC), Family Health Teams, Diabetes Education Programs and other services. Dr. Michael Brent, a national lead for our Diabetic Retinopathy Screening Goal Group, has developed a screening program with expert technologists in the inner city and remote communities with high rates of diabetes. Using a portable retina imaging system, a technician travels between sites, provides the DR screening eye exam as well as diabetes education to each person screened. Retinal images are uploaded to a server and evaluated in a timely manner by an ophthalmologist – retina specialist. For those individuals at risk or who require intervention for sight-threatening DR, referral is made immediately and timely care provided by the retina champions in each LHIN.
This group has demonstrated the feasibility and the efficacy of diagnosing previously undetected sight-threatening disease. The program has been deemed a priority project across all Ontario LIHN’s and provides an excellent example of increasing accessibility for equity of care and scale-up potential for this program in other Provinces and Territories. For example, the DR screening program, under the leadership of Dr. Stephen Kosar in conjunction with the Manitoulin Central FHT and OTN, is currently examining the entire population of Indigenous Peoples living with diabetes on Manitoulin Island.
In British Columbia, our Retinopathy Screening Goal Group co-lead Dr. David Maberley is establishing the pragmatic evaluation of two new screening sites, one in the remote Bella Bella Heiltsuk First Nation community and one in east side downtown Vancouver. These will be highly valuable sites for modeling effective community-based diabetic retinopathy screening. Using new software for retina image data capture and transfer technology, this group aims to automate image analysis to improve efficiency and triage of patients into higher and lower risk for treatment and follow up by primary or specialist care team.