I thought ophthalmologists would be delighted. Yes, they might lose revenue from office visits to screen negative patients. But if millions more patients with eye disease were discovered, they'd have more patients to treat. But within this group there is caution and skepticism.
Trexler Topping, MD, a Boston ophthalmologist and chairman of the American Academy of Ophthalmology's Health Policy Committee, sees numerous problems with a system that would rely on primary care physicians to do eye exams in diabetic patients.
"There is a role for screening in telemedicine, and I think that is certainly going to be used in the future, especially in isolated areas and Indian Health Service populations. It's already being widely used in the Veteran's Affairs Health System where there is not sufficient access to care," he says.
But for starters, the quality of the fundus images is so poor, 10% of the pictures must be thrown out. "For a significant percentage, we just don't have the answer after the picture is taken," he says. (Garg contends that fewer than 5% of the pictures are unusable.)
Second, Topping says, people with diabetes also have higher rates of macular degeneration, cataracts, and glaucoma. If primary care providers screen just for retina disease, other eye diseases that an eye specialist would likely have caught may be missed.
But wouldn't that all be offset when so many more patients are referred as having retina disease? I asked. And wouldn't those patients who have retina disease also be the ones more likely to have glaucoma or cataracts?
"There's no question you would capture more disease if you did indeed screen a higher percentage of the population," Topping replies. "But that's not the optimal way to do it." The eye specialist's equipment and training is just better, he says.