8 Minutes
By: Edward Chaum, M.D., Ph.D., Margy Ann and J. Donald M. Gass Chair in Ophthalmology, Vanderbilt Eye Institute (Emeritus)
Diabetic retinopathy is the leading cause of blindeness among working-age adults in the United States.
While ophthalmology clinics are the traditional setting for diagnosis, the reality is that 40% of patients living with diabetes never make it to a specialist. That's why expanding diabetic retinopathy detection into primary care, home care, and mobile health environments is not just innovate — it's essential to help ensure patients have access to this exam.
As an ophthalmologist, I’ve seen how early detection can help preserve vision. But I’ve also seen how fragmented systems and missed opportunities potentially delay care. The good news? We have the tools and models to help change that — starting with solutions like the Welch Allyn RetinaVue care delivery model.
First, the obvious — Ocular Telehealth programs help increase access to exams. Ocular Telehealth programs allow us to reach patients who might otherwise fall through the cracks — those in rural areas, underserved communities, or who can’t make it to a clinic due to work, transportation or mobility issues. With remote retinal imaging and cloud-based platforms, we can bring the diabetic retinopathy screening to them.
Primary care clinics, home health visits and mobile units are increasingly tasked with identifying diabetic retinopathy — but they face unique challenges.
Limited Resources: Many primary care and home health teams may lack access to retinal imaging equipment and existing clinical workflows.1 In one study, only 12.1% of diabetic patient visits in primary care included a documented fundoscopic exam, and none of those exams detected diabetic retinopathy.2
Patient Engagement: Patients may not understand the importance of eye exams, especially when they feel asymptomatic. Diabetic retinopathy often has no noticeable symptoms. A CDC study found that while 93% of patients knew diabetes could cause blindness, only 55% had received a DR screening in the past year.3
Referral Gaps: In different point-of-care settings, referrals to specialists can be delayed or lost. Without solutions like EMR integration, adequate staffing to complete patient outreach, and follow-up workflows, patients may not receive the care they need.1
Despite these challenges, there are several opportunities to improve diabetic retinopathy detection across care environments.
Telemedicine and Ocular Teleahealth Imaging: Portable retinal cameras and cloud-based platforms allow images to be captured in primary care clinics, mobile units or even patients’ homes — and reviewed remotely by specialists. The RetinaVue care delivery model exemplifies this approach. It enables retinal exams to be performed during routine primary care visits, with results returned by remote ophthalmologists typically within one business day.
Community-Based Programs: Mobile health units and partnerships with local organizations such as Lions Club chapters can bring screening directly to underserved populations. These programs can be effective among patients with transportation or financial barriers.3
Home-Based Care Models: As home health expands, integrating diabetic retinopathy exams into routine diabetes management visits can help improve access. With portable imaging devices and remote interpretation, home care nurses and technicians can play an important role in early detection.4
Patient Education and Empowerment: Educating patients about diabetic retinopathy during primary care or home visits has the potential to improve patient engagement with their care.5 Using culturally relevant materials and teach-back methods can help ensure patients understand the risks and the importance of having an annual exam.
To support improved diabetic retinopathy detection in primary care, home care and mobile health settings, providers can adopt best practices that help close diabetes care gaps.6 Diabetic retinopathy detection doesn’t have to be confined to the ophthalmologist’s office. By expanding exam access into different care settings — leveraging solutions like the RetinaVue care delivery model — we can potentially identify vision-threatening pathology, help provide exam access to more patients and reduce preventable blindness. When we meet patients where they are — whether in a clinic, a mobile van or their living room — we aren’t just detecting diabetic retinopathy, we are helping to protect vision.
