Retinal Screening of Patients with Diabetes in Primary Care Clinics Why Has Uptake of This Promising Idea Been So Low?

Abstract

Diabetic eye disease is the most common form of blindness in the industrialized world. Many cases could be prevented via screening. Unfortunately many patients with diabetes do not receive retinal screening because of the logistics in getting to an ophthalmology appointment. To address there has been a push to have retinopathy screening at the primary care physician practices through telemedicine. It is a compelling idea with data to support its effectiveness, but few primary care doctors use it. In 2015, based on publicly available records on providers who serve the Medicare fee-for-service population, only 255 non-ophthalmologist billed for more than ten teleretinal screening sessions.

In this chapter, based on our interviews with primary care physicians in USA (approached 200 of them), we describe the underlying reasons and potential solutions. We found only few primary care providers (PCP) have implemented such screening into their practice. That number is unlikely to increase until camera manufacturers bring down the upfront costs of fundus cameras, logistical barriers are addressed, and new payment models are introduced to make teleretinal screening more attractive to PCPs.