Local doctors have a new vision for screening eyes

OPHTHALMOLOGIST DR. CHRISTOPHER Brady of the University of Vermont Health Network, left, and Dr. Natasha Withers of Porter Medical Center display a new Fundus camera that is providing diabetes patients more convenience in getting critical eye screenings. The camera takes photos of the back of the eye, which can then be sent electronically to physicians in other offices to flag potential retinal problems.

MIDDLEBURY — New technology is helping local diabetes patients more easily test — and get follow-up treatment — for eye ailments that could rob them of their sight if left unchecked.
The University of Vermont Health Network’s “ocular telehealth” program has been introduced at two Addison County medical practices: Porter Primary Care Vergennes and Middlebury. The free service allows diabetes patients, during their regular doctor’s appointments, to have photos of their eyes taken by a Fundus camera that captures images of the retina. Those photos are then electronically sent to UVMHN ophthalmologists like Dr. Christopher Brady, who can flag any potential problems that might require an in-person, follow-up visit with an eye doctor.
It’s a convenient, no-fuss procedure that doesn’t require dilation of the eyes. And it can pay huge dividends, in terms of detecting the early signs of potential debilitating ocular ailments — most notably Diabetic Retinopathy, characterized by damage to the blood vessels of the light-sensitive tissue at the back of the eye.
“When we can identify Diabetic Retinopathy, we’re very optimistic about preventing or treating vision loss,” Brady said during a recent interview at Porter Hospital. “So this is a true public health opportunity, that if we can identify the disease, we can look in the face of the most common form of vision loss in working-age people and make a big difference with treatment.”
Diabetes, characterized by elevated blood sugar, produces a number of symptoms, including blurred vision, tingling in the extremities, fatigue and kidney disease. Patients should get an eye exam each year, according to Brady. Trouble is, only 20-60% of the people nationwide who should be getting exams are getting them every year, said Brady, pointing to recent surveys.
People who aren’t getting their regular exams might be homebound, busy, intimidated by the examination process, forgetful, or concerned about the cost.
“Many of them have no visual symptoms, so they won’t see the need from their standpoint,” Brady added.
Eye exams are particularly important for people who’ve had diabetes for a decade or two, according to Brady.
“After they’ve had it for 10-20 years, they will have some damage,” he said. “That may or may not be vision threatening, but it’s likely that after 10-20 years there may be some detectable changes.”
Physicians want to see at least 80% of diabetes patients receive their yearly eye screenings. That would place the American public on par with other groups, like the Veterans Administration and the United Kingdom National Health Service, according to Brady.
It’s no coincidence that the groups with the highest use of eye exams have ocular telemedicine at their disposal, officials noted. And that’s in large part due to the ease of that process. Once a diabetes patient has completed the medical checkup,  he or she is led over to the Fundus camera. They’re asked to simply place the chin on a rest and the camera does all the work, scanning each eye. The camera is wired into the internet. Special software allows the images to be instantly transmitted to an ophthalmologist off site.
The cameras are not only easy to work, they are mobile. They’re 23 inches wide by 22 inches long and 13 inches tall. They each weigh around 42 pounds, and thus can be moved from room to room.
Since its launch at Porter last September thanks to a two-year grant, the ocular telehealth program has thus far served around 55 county patients. And it’s already proven its worth in a big way; Brady said the photos have flagged potentially serious eye conditions in a handful of the patients. While most of the patients have “made the grade” in terms of ocular health, it has given others the impetus to get in-person eye exams in order to avert the prospect of further vision setbacks.
Getting good results through the program has given peace of mind to a lot of people.
“We were able to tell them that ‘from the standpoint of your diabetes, you don’t need to be seen right now,’” Brady said. “That’s what we think of — give them the convenience of getting it done at the moment, and give the primary medical provider that communication right away.”

Sarah Chistolini is senior telehealth program strategist for UVMHN. She noted results from ocular telehealth photos can lead to a patient being seen by an ophthalmologist within a few weeks, as opposed to the three months it might take through a conventional referral.
The Fundus camera is much easier than the traditional process of taking retinal photos, according to Brady.
“A traditional, in-the-doctor’s-office camera requires a lot of moving and focusing and things like that,” he said. “It’s really a skill. A high-quality doctor’s office in the past always required a skilled photographer to take high-quality photos.”
Brady and Chistolini hope folks take advantage of the ocular telehealth program not only while its free for the next 18 months, but in the long-term.
“The idea is that in the future, we would hope insurers, employers and patients will see value in this and make it more sustainable in that way,” Brady said. “There are ongoing costs of the program and the software that we use. If we want to expand it, we’d have to buy more cameras.”
Reporter John Flowers is at [email protected].

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