We don't stress the gravity—to patients or other practitioners—that this disease leads to blindness. But if caught early, surgery or other treatments can prevent 90% of patients from progressing to serious vision loss.
We don't compensate primary care doctors to screen. We could have primary care doctors use the patient checkup to get retina photographs. Doctors would have to buy $25,000 cameras that are easy to use and don't require eye dilation, (the cost may dramatically drop soon) then use telemedicine to have contracted retina specialists evaluate the images.
But payers won't reimburse doctors what it would cost, even though it would capture more disease, be cheaper than paying an ophthalmologist, and be a better solution than letting disease silently progress, further damaging other vessels like those in the heart.
We allow turf battles between eye specialists and primary care doctors to block solutions in a way that defies common sense.
Tillman Farley, MD, medical director of Salud Family Health Centers, a practice with 5,000 diabetes patients in Ft. Lupton, CO, agrees. "The way we're doing this today is not a good way, and we'll continue to lose a lot more vision if we continue this way."
Diabetic retinopathy "is a perfect disease to screen for because it has a long silent period. And with this disease, it really matters if you catch it."
James M. Gill, MD, president of Family Medicine at Greenhill in Newark, DE, agrees.
"Anytime you have to refer a patient out of your office, the probability they will get the recommended care goes down dramatically," Gill says. "This would significantly increase the chance this will get done."
This is huge, because diabetes is expected to mushroom in the next 30 years from 26 million people today to 125 million.
Some primary care doctors argue that they don't have time in their busy practices, with all the things they have to worry about already. But they should make time, and payers should compensate them for that.