Failure to Manage Diabetic Eye Disease Screenings Carries Staggering Costs

Ticking time bomb in the eye

I said this earlier, but it bears repeating; Catching vessel damage in the eye can signal asymptomatic damage to other important organ systems such as the vessels of the heart.

"The eye is the only place in the body where we can see blood vessels without having to cut into the body first. So many patients don't know they have a ticking time bomb in their eye," says Seema Garg, MD, a retina specialist at the University of North Carolina, Chapel Hill.

The solution is obvious, but requires a major change in the way primary care medicine is practiced. Once a patient is diagnosed with diabetes, doctors should make the exam simple and easy-to-get.

In a Research Letterpublished Monday in the Archives of Internal Medicine, Garg gives evidence that moving diabetic retinopathy screening from the ophthalmologist's office to the primary care practitioner is effective through telemedicine.

In Garg's study of 1,002 patients with diabetes, when screening was done in an outpatient clinic and images were sent to her electronically, rates of screening rose from a historical 32% to 71% after 12 months. She identified 133 patients with disease who probably would not have gotten care otherwise.

"We can't afford not to do this," Garg says.

Charles Cutler, MD, a Norristown, PA internist and member of the American College of Physicians Board of Regents, thinks Garg's proposal is "great" because he knows how hard it is to get some patients to do what the doctor says. "Sometimes I find the prescriptions I've handed them lying in the parking lot outside," he says.

Another part of the problem is "the turf battle with ophthalmologists," he says.