Computers bridge distances: Vision program improves lives of diabetics

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The ophthalmologist and retinal surgeon – under the leadership of Dr. M Mathen, head of Misericordia Health Centre’s (MHC) Eye Care Centre of Excellence – helped set up the computer-based Manitoba retinal screening vision program and its impact has improved the lives of hundreds of northern residents with diabetes.

Launched in 2007, the $2-million program is supported by Misericordia and the Winnipeg Regional Health Authority in collaboration with key partners including the J.A. Hildes Northern Medical Unit (NMU), Edmonton Regional Telehealth in Alberta, CNIB, First Nation and Inuit Health, and Manitoba Health and Healthy Living.

It targets residents mostly in the Burntwood and NOR-MAN regional health authorities, in over 50 communities including Thompson, The Pas, Gillam and numerous First Nations communities.

Four regional eye care outreach nurses from Burntwood, NOR-MAN and NMU run clinics in various locations that include taking photos of patients’ eyes with a specialized digital camera. The photos are transferred and stored in a computer at a central interpretation centre at MHC within a few days of being taken. A report is also generated and a clerical assistant at MHC co-ordinates any consults or referrals to Winnipeg.

“What’s special about this program is that (the nurses) do seven sets of photos per eye and they do some of them, the ones that are clinically important to know, in 3-D,” Dookeran explains. “When combined with the technology that I use to view the images, it gives me a three-dimensional image of the retina. This has been really critical. By being able to assess depth and thickness of the retina, I can actually assess certain pathology or absence of pathology and that helps me determine whether or not I need someone brought down to (Winnipeg) for treatment.”

In 2007-08, 891 patients were screened and 193 (21 per cent) were referred to a doctor, optometrist or a retinal, glaucoma, cataract or general ophthalmologist. In 2008-09, 1,326 people were screened and 123 referred (nine per cent).

“The biggest impact is access to health-care from an eye specialist’s point of view,” says Dookeran. “On average, for patients to be seen and screened (before the program), it could have been anywhere from four to six months. “Now if somebody is an emergency and it shows up on the photos, they can be notified and the patients are seen within a few weeks – or sooner if necessary.”

He believes the program has also attracted people who otherwise wouldn’t have had their vision checked. Residents normally had to travel to Winnipeg or hope to get an appointment with the handful of ophthalmologists or optometrists who do fly-in trips. Now they may only have to travel an hour to a clinic, or will be seen in their home community and will not have to travel at all.

“We can cover a far greater number of people in a shorter amount of time at lower cost to the system,” says Dookeran, adding there are four retina specialists for Manitoba, northwestern Ontario and parts of eastern Saskatchewan. “If a patient can receive the care within their own environment surrounded by friends and family-that is less disruptive to everyone. That’s very important. And patients who would otherwise not get checked because it’s too far to fly or to what extent optometry visits are covered, this (screening) is done at no charge to the patient.”

Case in point was one man who decided to go to a clinic even though his vision was close to 20/20. What the screening showed was that his diabetes was out of control and there was a high risk his retina could detach. “He was referred down immediately and underwent laser treatment, which prevented him from having to go to the operating room which would lead to more potential involved care. He had no idea he had a problem,” says Dookeran

Patients can also see their photos and have the situation explained to them. “It helps educate patients and that’s a huge, huge factor in helping patients help themselves,” Dookeran says. “Blood sugar control often gets better when patients understand what we say when we say there’s damage at the back of their eye.”

Similar programs are run in Alberta and parts of Ontario, and most recently in Victoria, which serves patients in remote parts of Vancouver Island. “What I love about this program, and what I’m really pleased to see has actually gone into place and been working quite well, is that we’ve now reached further than our city centre to make sure that everybody is getting the highest possible quality of care,” Dookeran says.

“And if we can continue to expand and improve access, it overrides the challenges of remote health care service provision and moves toward equity on those locations in the province where this innovative program is delivered.”