Primary Care Story:
Lyn Berry, MD
Director of Primary Care - Alameda County Medical Center
"...We have actually been able to prevent advanced eye disease blindness..."
"Our problem is as a very busy urban public hospital diabetes clinic, everyone needs to be screened, but we have limited access to eye services and we weren’t able to differentiate people who really needed services soon versus people who could wait until an appointment could actually be scheduled for them.
The ophthalmologists love the program because we are actually able to send them referrals that are very appropriate to the services they offer. Patients like EyePACS because the photos are used at the point of care to help educate them.
When any significant retinal disease is picked up through the EyePACS system, we are able then to target those referrals as urgent referals, give the patients an appointment, and we’ve found that our compliance with eye exams went from around 25% up to the high nineties.
We have actually been able to prevent advanced eye disease blindness, and it’s really been an enormous quality tool for our clinic."
DiabetES Patient StorIES:
Patricia Andrade, Patient
"I didn't know I could lose my vision until I went to my doctor and they did an exam."
I had never had an eye exam before. My doctor’s assistant took pictures of my eyes with a special camera. That’s when they showed me how my eyes could end up and how they were bleeding inside and all that."
Patricia Andrade, a 23 year-old Latin American woman with uncontrolled diabetes, was referred by her primary provider to a retinal specialist. Although her latter retinal pictures revealed that she had serious microvascular changes, the retinal exam form of the specialist noted no detection of retinopathy.
Fortunately, this patient’s case was brought to the attention of the EyePACS team, and they asked her to come back and captured more images. Her images were then sent to and reviewed by two retinal specialists, one at Berkeley and the other at Columbia University. Both concurred that she had severe retinopathy that required prompt treatment. This patient’s narrative highlights the importance of the use of digital images to detect sight-threatening diabetic retinopathy, and the efficiency of telemedicine in obtaining various consultations within a short amount of time.
Ricardo Hernandez, Patient
“Words cannot express my gratitude. After the surgery, I was able to experience one of my greatest joys – to see my beautiful granddaughter for the very first time…”
As a result of diabetes, Ricardo Hernandez had significant deterioration in his eyesight for more than seven years. Concerned that he would permanently lose his vision, Ricardo learned about a free retinal screening program offered at a nearby community clinic, supported by Scripps Whittier Diabetes Institute.
Ophthalmologist Paul Tornambe, MD,and George Hayes, manager of Scripps Whittier’s mobile medical unit recognized the urgency of Ricardo’s situation and immediately began a series of treatment to save his vision. Ricardo had severe retinopathy and clinically significant macular edema, which would lead to blindness if left untreated.
“Each time I had a treatment, I felt a little better,” said Ricardo. “I believed the doctors were going to save my eyesight – and my livelihood. If I went blind, there would be no way I could support my wife, my children and my grandchildren.”
Because of the severity of Ricardo’s case, he also needed retinal vitrectomy surgery. Through the collaboration of Scripps leaders, physicians and staff, Dr. Tornambe successfully performed the surgery at Scripps Memorial Hospital La Jolla.
More than 100 patients receive retinal screenings each month through the Scripps Whittier Diabetes Program. The program is made possible by contributions from Blue Shield of California, Fonseca Foundations and Scripps Community Benefit Program.
“Words cannot express my gratitude,” said Ricardo. “After the surgery, I was able to experience one of my greatest joys – to see my beautiful granddaughter for the very first time.”
Reference: The Ricardo Hernandez Story: An Eye-Opening Experience. By Scripps Health. Online at http://www.scripps.org/about-us__giving__testimonials__the-ricardo-hernandez-story.
Moua Thao, Medical Assistant/Retinal Photographer - Golden Valley Health Center
“...This camera is a regular camera and this is a special lens--it is very easy to take a picture. It takes me about 5 minutes..."
Images of patient’s eyes revealed a brain tumor.
Moua Thao’s role and choice of action as a retinal photographer of the EyePACS Telemedicine program had a significant impact on a family member’s life, bringing the EyePACS experience even closer to home. Moua Thao’s cousin, Michael Cheng Thao, who lives in the San Joaquin Valley, complained to his doctors of blurred vision, dimmed hearing and dizziness. He was then recommended to see an eye specialist immediately, but was told that the only appointment available within his area was two months away. As his condition worsened and with a language barrier, Cheng Thao had no other resource to turn to for help except for his cousin, Moua Thao, who worked as a retinal photographer at a nearby clinic in Merced.
Moua Thao suggested to his cousin to come visit the clinic for a quick capture of the retina, so Cheng Thao followed this advice. Moua Thao took pictures of Cheng Thao’s eyes and uploaded the images to the clinic’s website. The images were reviewed five minutes later by an optometrist 400 miles away in San Diego, who diagnosed swollen optic nerves, and recommended that Cheng Thao pay a visit to the emergency room immediately. About two weeks later, Cheng Thao had a non-malignant tumor removed from his brain. With the efficiency of telemedicine, Cheng Thao was fortunate to reach a specialist in time to save his sight.
Reference: Eye Witness: U.C. Berkeley optometrist's long-distance diagnosis technology saves sight. By Cynthia Dizikes (June 2007).Appeared in the Monthly Volume 37, no. 9 (June 2007), and online at www.themonthly.com/eastbayLife06-07.html.
Christine Noguera, Deputy CEO
Golden Health Medical Center
“...If we can avoid one patient from losing their sight by doing these exams on site, the program is a total success…”
"There is not really a great additional cost incurred by the clinic. For the patient, that’s good because the eye exam is integrated in the office visit that they have already paid for, so there is no additional cost to the patient. That’s really increased compliance and their ability to get that exam. That office visit is reimbursable; the procedure is reimbursable.
If we can avoid one patient from losing their sight by doing these exams on site, the program is a total success."
Medical Director Story:
David Martins, MD & Medical Director - T.H.E. Clinic, Inc.
“...He might have gone blind within three months waiting for an eye exam. I couldn’t take that anymore...”
"The waiting time for diabetic patients to get their eye exam by ophthalmologist using county system can take up to 6 months to a year. Recently, I saw a newly diagnosed diabetic patient, and scheduled an ophthalmology exam. By the time I saw him six weeks later, he had already gone blind. He might have gone blind within three months waiting for an eye exam. I couldn’t take that anymore. That is why I decided to institute diabetic retinopathy screening within T.H.E. clinic, so we can identify patients who are at risk and prevent diabetic blindness.
At least we can take the retinal scan and identify those high risk patients for early intervention, so that we don’t have any more of our patients go blind."