Telemedicine solution – with volunteer support - prevents diabetic blindness in central Mexico

In the mountains of Central Mexico sits the old Spanish silver mining town of Guanajuato, designated by UNESCO as a World Heritage Site and also cited by the World Health Organization for one of the highest rates of type 2 diabetes on the continent, with up to 15% of the adult population affected. The Secretaria de Salud de Guanajuato (Health Ministry of Guanajuato) has established an extensive network of community health clinics where people with diabetes can receive medical care under Seguro Popular, the Public Health Insurance program funded by the Mexican federal government since 2004.

However, due to scarce resources, the program was unable to address prevention of blindness caused by diabetic retinopathy. We know that regular annual retinal evaluations of asymptomatic diabetic patients, followed by prompt laser treatment, can prevent vision-threatening disease.

EyePACS proposed that local medical personnel could capture retinal images from diabetic patients using a nonmydriatic digital camera in the community health clinics, and then transmit the images to the EyePACS LLC website for evaluation and referral. Partnering with Vision for All, a nonprofit NGO based in St. Paul, Minnesota, as well as Rotary Clubs in Mexico and the U.S., the required equipment was funded and donated.  Since 2006 EyePACS has worked with the Secretaria de Salud de Guanajuato to implement that program.

In 2010 EyePACS LLC trained local primary care physicians from nine municipalities in the region of San Miguel de Allende (Sanitaria Health District II) to capture retinal images and upload them to the EyePACS LLC website. The digital retinal camera was then rotated to each of the municipalities for periods of 2-6 weeks. Volunteer ophthalmologists and optometrists from Mexico and the U.S. were trained to access and evaluate the images remotely using the structured EyePACS grading template. Patients with vision-threatening retinopathy were identified and recommended for laser treatment, performed locally by Guanajuato ophthalmologists and by visiting volunteer ophthalmologists from Mexico, the U.S., France and Belgium.

Within nine months of starting the program, 2,029 (60%) of the diabetic patients in the area were screened and 225 (11.1%) referred for vision-threatening retinopathy. After four years, 5,500 retinal screening encounters had been recorded.

The Secretaria de Salud de Guanajuato has now expanded the project to include three additional Sanitarias, and EyePACS has provided additional photographer training. A total of 1282 additional patients were screened.

EyePACS continues to work closely with the Secretaria de Salud de Guanajuato in order to expand the program to the rest of the State, using the ongoing volunteer services of image graders and laser surgeons. To read the entire article, with images, click here.