Diabetic retinopathy (DR) is the most common cause of vision loss among working-age adults. Treatment of late-stage DR can cost as much as $28,000 per patient, while early-stage treatment costs are minimal.
No one has to lose vision to diabetic retinopathy — those who do usually don't know that they have it or find out too late. Early screening and treatment prevent vision loss in 90 percent of cases. However, because it is asymptomatic until later stages, many DR patients are unaware of the disease.
Traditional eye exams require an office visit to an eye doctor, take considerable time, and require pupillary dilation, which causes hours of disruptive blurred vision. Because of this time consuming and negative experience, some patients are reluctant to complete screening.
In 2015, only 22 percent of Penn Medicine patients met recommended screening standards for diabetic eye care. However, 8,900 of these patients came to Penn Medicine for other services. These "on-site "health care interactions represented a missed opportunity to assist non-adherent patients in getting sight-saving diabetic eye exams.
Eyes on Site (EOS) is a retinal screening model that makes it easy for patients to meet recommended screening standards for diabetic eye care.
Rather than requiring a standalone visit for screening, EOS is deployed in Penn Medicine locations with high volumes of diabetic patients, such as endocrinology and primary care. Patients are offered free, rapid retinal screening while they are on-site for other appointments. Most notably, EOS leverages non-mydriatic cameras - which do not require pupil dilation - to conduct screening.
Images are interpreted remotely, and findings are quickly communicated back to patients and providers.
EOS offers a superior retinal screening experience and drives better patient outcomes.
We saw impressive results in our pilot population.
- Increased screening rates: We engaged non-adherent patients in diabetic eye screenings. Of the 125 patients screened, 47 percent did not know when their last screening was or reported never completing one.
- Improved patient experience: EOS screenings are 18x faster than traditional retinal screenings, and they don't require pupil dilation, which means patients can drive themselves home afterward.
- Earlier diagnosis: We discovered previously undiagnosed diseases within pilot participants, with 57 percent requiring a referral, either for baseline or detected eye disease, and 11 percent presenting with evidence of DR.
The EOS model enables earlier diagnosis and treatment for DR, thereby reducing poor patient outcomes and decreasing the need for costly late-stage diabetic eye disease treatments. If EOS screened 890 patients yearly, we predict 356 cases of undiagnosed disease, amounting to more than $290,000 in cost avoidance.
When the COVID-19 pandemic reached Penn Medicine, the EOS model provided a foundation for the development of the Telemedicine Enhancement Pathway (TEP). TEP expedites in-person ophthalmology care through the use of advanced retinal imaging and eye testing. After on-site visits, ophthalmologists review studies and complete the anterior portion of eye exams via telemedicine. TEP reduces the time patients spend in the office from up to three hours down to only 30 minutes. It also enables for safe social distancing for patients whose medical conditions require a full in-person exam.