"It's not rocket science."
Farley, at Salud Family Health Centers, uses a fundus camera to screen patients and has learned how to read them himself rather than relying on telemedicine for a retina specialist. There's a simple accepted algorithm, he says. "It's not rocket science."
In the process he avoids a screening cost of about $35 per patient.
"We save way more vision and prevent way more blindness in our system than in any system that depends on an ophthalmologist for screening," he says "even with a test that is not quite as good."
And, telling the patient they could go blind really gets their attention, persuading them to get blood sugars under control more effectively than vague warnings about other health consequences far down the road, he says.
Unfortunately, Farley says, "you get into big turf issues if you go to an ophthalmologist and say family doctors can read these films. You'd get some pushback on that."
He was right. Topping heatedly disagrees, saying that proper training requires far more time than three hours.
Clearly, some details will have to be worked out.
Bottom line, says Garg, is that "the dollars and cents are going to bring a lot more attention to this than the social value of preserving vision. The more you let the smoldering fire burn, the more it's going to take. We have a great opportunity for a partnership rather than a food fight."