By Krista Lamb
In working-age Canadians, diabetic retinopathy is the leading cause of vision loss. This vision loss is often preventable with early detection and treatment. Even before the pandemic created a greater gap in services, 40% of people living with diabetes in Ontario had not had an eye exam for more than two years. Many of those people are from low income communities.
This gap is the reason Diabetes Action Canada researchers have developed Project OPEN.
The project uses medical records data to identify people who haven’t been screened, then community health reaches out to offer pre-screening, explains Dr. Michael Brent, a Diabetes Action Canada researcher and Associate Professor of Ophthalmology & Vision Sciences at the University of Toronto. “The patients loved it,” Brent says of the pilot project at Toronto’s Women’s College Hospital that validated the study idea. “If you can identify them, they will come.”
Project OPEN uses community health centres—currently 13 in the Toronto area with plans to expand to more than 70 across the province—to perform the outreach and arrange screenings.
A Diabetic Retinopathy Screening Program with mobile imaging equipment has been developed to target areas with low screening rates. Images and health data collected are uploaded to a secure server at Ontario Health. Images and data are graded remotely by retinopathy specialists and care recommendations provided back to the primary care provider.
Having community health centers perform the outreach takes the burden off busy family practitioners, while ensuring that the work is done by health care workers that patients can trust. “They have really good primary care teams at the community health centres and they have good interactions with their patient population,” says Brent. “If they’re able to reach out to people living with diabetes we’re really hopeful that this will boost screening uptake for vulnerable populations.”
Currently, there is a disconnect with tracking eye exams. Electronic medical records don’t identify if someone has been screened and there is not a standard system to connect patients with eye care. Family doctors will suggest an eye check and may even provide information on local clinics, but they don’t have a method to follow-up or find out if the patient attended and what the outcome of the exam was. “Optometry is not required to send a letter back to primary care to complete the loop, so without the provincial health care data we really don’t know [if someone has been screened],” says Brent.
Project OPEN will be the first use of provincial digital health assets to enable population health management in Ontario. “It will allow patients to engage in their own health care, especially vulnerable populations, and it will build capacity for diabetic retinopathy screening,” he explains, while also building capacity for diabetic retinopathy screening through digital media and teleophthalmology.
“If we are able to identify diabetic retinopathy early enough, we can prevent vision loss and blindness, so screening programs are really important,” says Brent.
The project is being supported with funding from Fighting Blindness Canada. The Diabetes Action Canada Health Technologies and Assessment team, led by Dr. Valeria Rac, is also working on Project OPEN, learn more about their involvement in this recent article.
Reducing the Risk of Diabetic Retinopathy
Episode five looks at Project OPEN and its potential to reduce the risk of diabetic retinopathy. Malcolm Sissmore and Dr. Michael Brent from UHN Research discuss how this program is trying to make eye screening much more accessible for people living with diabetes.