New technology helps diabetes patients in remote communities get the eye disease screening and treatment they need
A team of Edmonton ophthalmologists has developed an innovative technology that links eye specialists in urban centres with patients in remote communities. While the technical achievement itself is notable, the real innovation lies in the result – improved patient care at a reduced cost.
Now, patients with diabetic eye disease who live outside major centres can be "seen" by an ophthalmologist without leaving their home communities. Digital images of their eyes are transmitted to Edmonton, where a specialist reviews the images and makes a diagnosis. The system saves time as well as travel and accommodation costs. Most importantly, it makes it easier for many people to have the eye exams they require.
The technology is used to screen for and diagnose diabetic retinopathy, the leading cause of vision loss in North America. The high blood glucose levels of diabetes can damage the retina's blood vessels, eventually leading to blindness. (The retina lines the back of the eye. Its nerve cells capture light like the film in a camera and send the messages to the brain.) Laser treatment can prevent progression to blindness in diabetic retinopathy, so it is critical to make a diagnosis before vision is affected.
Remote eye disease screening is a particular boon to native communities. Canada's aboriginal people are three to five times more likely than non-natives to develop diabetes and, as a result, they have a higher risk of diabetic retinopathy.
"Diabetic retinopathy is a very serious complication of diabetes," explains Dr. Matt Tennant, the Edmonton ophthalmologist who pioneered this technology along with his colleague Dr. Mark Greve. "People with diabetes should have their eyes looked at once a year. When they start to have eye problems, checkups should be even more frequent. It's unreasonable to expect people from remote communities to meet this kind of schedule. We saw a better way."
The better way was "teleophthalmology." Tennant's research team began a pilot project in 1998 to develop the technology with northern Alberta's Fort Vermilion as their test site. This predominantly native community, which has a high rate of diabetes, has no local ophthalmologist and is a 12-hour bus ride from Edmonton. Only about one-fifth of Fort Vermilion residents make their way to Edmonton for regular eye exams. The project proved the new system's viability, both in terms of identifying people in immediate need of laser surgery and establishing the cost savings from remote diagnosis.
Unfortunately, the road to technology development does not always run smooth. When funding for the pilot project came to an end, the research partner that developed the imaging software pulled out. Without access to the software, the team was missing a key part of the system. "But Mark (Greve) and I weren't going to let this drop," says Tennant. Along with Dr. Brad Hinz, Chris Tennant (Matt's brother) and Jayson Eppler, they set up a company called Secure Diagnostic Imaging (SDI) and started again.
Unlike the original technology, SDI's approach involves a web-based system. A technician takes digital, 3-D photos of a patient's eyes and the images are then sent – couriered via CD or transmitted via satellite or the Internet – to SDI's secure server. Ophthalmologists access the images and review them at a workstation using stereo goggles. SDI's software grades the image, allowing the doctors to diagnose the level of diabetic retinopathy. The software is what makes the system so valuable – it not only allows doctors to screen for diabetic retinopathy but also helps them determine the severity of the disease.
Tennant explains: "In the aboriginal communities we serve, approximately 30% of patients have diabetic retinopathy but only about 7% of them need treatment. If we were just screening people, we would have to send the entire 30% to Edmonton for diagnosis. By diagnosing patients remotely, we're much farther ahead."
The system is now being used in a number of projects, the largest of which is Health Canada's SLICK project. (SLICK stands for Screen for Limbs, I-Sight, Cardiovascular and Kidney complications.) It sends mobile diabetic clinics to all 44 of Alberta's First Nations communities to screen for metabolic, kidney and cardiovascular complications of diabetes and to take digital retinal images using the SDI technology. The images are reviewed in Capital Health's teleophthalmology reading centre at the Royal Alexandra Hospital. The centre is expanding so that it can also be used for teaching and research.
With this practical experience, and research studies that demonstrate the reliability of the technology, Tennant is hoping to expand the use of teleophthalmology. One of his goals is to have SDI's system available in doctors' offices across the province. "For example, a patient in Cold Lake goes to their eye doctor, gets a photo taken and we analyse it. Already, it's as if an ophthalmologist has seen the patient. If the patient needs to come to Edmonton, everything can be scheduled beforehand for the same day: the specialist's appointment, further tests, even treatment. This would be so much more efficient than the current system where you see the ophthalmologist, then have to return to Edmonton for tests, then maybe even come back again for treatment."
Tennant is also looking beyond diabetic retinopathy to other eye diseases such as macular degeneration. "We're just at the beginning of seeing the very real benefits that can come from teleophthalmology," he says. "The potential is huge in a big country like Canada."
- Connie Bryson
Your Health Magazine - January - February, 2005 Issue
Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)
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