Innovations: Integrating diabetic eye screenings with primary care

Diabetic retinopathy is the leading cause of blindness in the U.S., and 4.5 million people suffer from some stage of the disease.

Early detection and treatment can reduce the risk of developing blindness by 95%, according to the National Institutes of Health, which recommends diabetics get annual dilated eye exams because the early symptoms aren't otherwise noticeable.

While many of the more than 29 million Americans with diabetes dutifully visit their primary-care provider to manage their illness, about half forgo yearly eye exams, potentially allowing irreversible eye damage to go undetected.

A company called Intelligent Retinal Imaging Systems, or IRIS, developed a cloud-based platform and image-enhancement technology that connects primary-care physicians with optometrists and ophthalmologists who can read eye exam images taken during a normal doctor visit. The company's goal is to create a workflow that makes it easy for doctors to order and administer the tests and have them analyzed.

“What we've found is the current process is very burdensome. There are a lot of onerous steps,” said IRIS CEO Jason Crawford. “We look at it as a comprehensive solution from intake to reimbursement.”

Rather than trying to sell physicians a camera for the exams, Pensacola, Fla.-based IRIS focuses on its technology, which integrates the exams with electronic health records and either connects doctors with eye specialists in their area or the exams are read by specialists at an IRIS-contracted center. The company has a contract with Johns Hopkins Hospital's ophthalmology institute for those readings, as well as medical director leadership.

IRIS, which is privately held, introduced its technology in 2013 and in 2015 received approval for the platform from the U.S. Food and Drug Administration. So far, the company has scored clients in 26 states and business is booming thanks in part to the CMS' focus on quality measures for physicians. As doctors become accountable for their patients' overall care, it becomes more important to make sure they are taking advantage of preventive health tests like eye exams.

“Now we're giving them the ability to do it,” Crawford said. “That's really driving adoption.”

And providers are seeing tangible results from making eye exams more accessible. The CoxHealth system based in Springfield, Mo., started using IRIS' technology in 15 of its 80 offices in mid-June, and it has diagnosed 291 patients with diabetic retinopathy so far. Before CoxHealth introduced eye exams into its primary-care visits, only 32% to 38% of its diabetic patients were going to specialists to get the test.

“There's a reason Medicare and insurance companies are placing a premium on this,” said Dr. Mark Costley, medical director for CoxHealth's regional services. “If you can catch (diabetic retinopathy) at low levels and get control of the diabetes, you can prevent really expensive treatment that comes with severe disease.”

The tests have also uncovered other issues in diabetic patients, including cataracts, macular edema, macular degeneration and even strokes in the eye. CoxHealth is planning to expand use of the tests in its clinic and outpatient settings.

Brock Shamel, CoxHealth's administrative director of regional services, said it's particularly rewarding to see the buy-in and results of the technology from patients and physicians. “A lot of times we send patients away with a plan, and we don't get to see the results of it,” Shamel said. “You get to see the results of this. That's a powerful thing when it comes to providing healthcare.”

Now, Crawford and IRIS are continuing to work with payers and states to break down barriers and make eye exams more accessible in primary care, with the support of groups such as the American Academy of Ophthalmology and American Diabetes Association.

Crawford said he finds joy in providing patients with access to care at the right time because prudent medical care saved his life in 2003 when he was injured in combat in Iraq while serving in the U.S. Army.

“At the end of the day for us, how many diabetic patients were we able to examine this week and how many of them have sight-threatening disease?” he said. “Those are the metrics that gauge our success.”