Diabetes is epidemic among Native Americans. But thousands now receive
annual eye exams, reducing their risk of diabetes-related blindness, through
the Indian Health Service’s multi-state teleophthalmology program.
W
e know that diabetes is the leading
cause of new blindness in workingage adults.
We know that it’s more common among
Native Americans than any other ethnic
group.
We also know that only half of Native
Americans get an annual eye exam, which
is key to effective treatment of diabetic
retinopathy, a disease that can eventually
lead to blindness.
It’s a public health crisis – and one that
telemedicine has made great progress
toward resolving.
“Telemedicine is pivotal for diabetic
retinopathy,” says Mark B. Horton, MD,
director of the U.S. Indian Health Service’s
multi-state teleophthalmology program,
a collaboration with the Joslin Diabetes
Center in Boston.
Research has shown that 95 percent of
the cases of blindness caused by diabetic
retinopathy are preventable, if the disease
is detected and treated promptly, Dr. Horton
says.
Since 2000, teleophthalmology has made it
possible for Dr. Horton to examine the eyes
of more than 80,000 Native Americans with
diabetes. His program started with 183
cases in 2000, and handled about 15,000
cases in 2013.
The teleophthalmology network connects Dr.
Horton’s Phoenix office to 86 Indian Health
Service (IHS) clinics in Arizona and 23 other
states.
For Native Americans and others who live
in rural communities some distance from
Tucson and Phoenix, getting to an eye
doctor is a logistical challenge, Dr. Horton
says. In addition, “An eye exam is not at
the top of their list of priorities, particularly
since they are usually asymptomatic until
the disease grows to advanced and less
treatable stages.
“Now we can take the eye exam to patients
wherever they may be,” Dr. Horton says.
He serves patients who live in Supai, at the
bottom of the Grand Canyon, where exam
equipment is delivered by helicopter, then
flown back out again, and in the Eastern
Aleutian Islands off the coast of Alaska.
According to the IHS Division of
Diabetes Treatment and Prevention,
teleophthalmology saves hundreds of
millions of dollars a year in medical care
and support services that would be required
for people who go blind. For that reason, the
IHS has made teleophthalmology mandatory
at all its hospitals and larger health-care
facilities.
“It’s far cheaper to prevent and treat this
disease than it is to treat the fallout of
untreated disease,” Dr. Horton explains.
“Telemedicine is pivotal
for diabetic retinopathy.”
Mark B. Horton, MD
“When a patient gets diagnosed with
diabetic retinopathy, they tend to have other
complications from diabetes as well.
Mark B. Horton, MD
Not all health plans pay for
teleophthalmology, Dr. Horton says, but
AHCCCS, Arizona’s Medicaid program for
low-income individuals and families, was
one of the first to get on board.
“AHCCCS recognized the value of this
almost immediately,” he says.
“But health care providers, and payers,
tend to be very skeptical, and that’s very
frustrating for folks like me. But when you
get right down to it, no human likes change.
The only thing that likes changing is a wet
baby.”
“Teleophthalmology has the potential to
have a profound effect on improving the
quality of public health, and decreasing
health care costs.”
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