Arizona Telemedicine May 2014 - Page 27

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.” 23