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on September 4th, 2007 | Filed under Optoblog

Is Retasure a good thing? Systems like this have been in place with the Indian Health Service in certain areas of the Southwest, but more on that later.

The Utah Optometric Association took exception to Retasure only saying the word “Ophthalmologist” and never even allowing for optometry to enter the picture. I take exception too, but if they have significant problems, they would go straight to the retina OMD guy/gal anyway; however, what are their referral criteria?

With any result other than no pathology, the American Academy of Ophthalmology and the American Diabetes Association recommend an immediate referral to Ophthalmology.

If there is any amount of retinopathy, they still refer to ophthalmology. Note, it doesn’t even have to be a retina specialist. General ophthalmologists are getting referrals that I, an optometrist, can manage. I can discern whether DR requires a procedure vs monitoring at specified intervals. Even after a procedure, I still monitor them and call or send a memo to the retina guy/gal about their progress. This exclusive “ophthalmology” wording is sick and wrong.

And I’m sure the system could be a potential cash cow for the PCP, but only if he has everyone do it- even if they would normally go see an eye doctor yearly anyway. I can foresee lots of patients getting upset if they find out their annual eye doctor visit isn’t covered because they already took a Retasure picture in the PCP’s office, so now they have to pay out of pocket for an eye exam to check their glasses. And us eye doctors are also going to want to check their eye health, and even if they could produce a Retasure photo, what about the anterior segment, vitreous, and peripheral retina health?

So, Retasure, did you really forget about optometrists or are you trying to make a political statement? Are you prejudiced against us? Do you suppose us not worthy to refer to? If so, check our training. We can handle diabetic eyecare. We also send notes to PCPs regarding the results.

But what about you? Do you really think this is a good system? Does it best serve diabetic people to be screened with this verses getting comprehensive eyecare annually? Eyecare which they probably want anyway so they can update their glasses and such? Also, in the Indian Health Service, they use this type of remote viewing system only in rural locations where there aren’t any eye doctors. Why do we need Retsure unless the PCP office is a significant drive from the nearest ophthalmologist OR optometrist office? And how many PCP offices fit that description? I’m sure not enough to make a profit for you.


5 Responses to “Retasure”

  1. Ray Siteman says:

    Did you see where Retasure received FDA approval? This group seems to be getting some attention with all the reading going to ophthalmologists, both lacally and at reading centers. Their we site does say referrals are ro retina specialists. Has anyone been in touch with Retasure?

  2. Gerry Skews says:

    Hi Folks,

    I recently read this entry with interest. I have to shoulder some of the responsibility for this as I helped develop the business model for taking the retasure service to market.

    Firstly, I should mention that we have more optometric customers worldwide than any other group of healthcare professionals. Our technology is used to provide preventative healthcare programs for more than 1 million patients a year and this would not be possible without the committment and support of the optometric community.

    The worlds’ largest single retinopathy risk assessment program is run by optometrists in the UK, this comprises of more than 30 independent optomterists linked via a network to three hospitals and manages more than 110,000 patients annually. In this model the optometrists provide photography and primary grading of pathology. The technology is designed to provide multi level grading so that when a primary grade is made that shows pathology the images are sent to a clinical ophthalmologist for a futher diagnostic assessment. A random selection of all images is also distributed to other optometrists so that we have a self regulating quality control function.

    This approach is cost effective, technically efficient, clinically valid and very patient friendly with over 80% of diabetic patients visiting their local optometrist for primary eyecare. I cannot speak highly enough of the professionalism and competence of these guys and gals.

    This is an example of a systematic, integrated large scale public healthcare program that is defined and ultimately supervised by a government regulated body.

    In the US, the provision of vision risk assessment is poorly served for patients at risk of blindness through DR, AMD and Glaucoma (not my words). If it was not already in the public domain I would also gladly plagiarize the recent AMGA report that states “In recent years, diabetes has emerged as a powerful indicator of the country’s systemic failures of chronic disease prevention and treatment. Considerable gaps exist between the clinically recommended guidelines for care and the actual patterns of guideline use”

    So make no mistake; I fully recognize the need to have the whole optometiric community fully engaged and committed to providing this level of care.

    In part, our issue came from clear legal advice that indicated all images must be read “In State, by board certified ophthalmologists” most optometrists I guess would want to read images locally rather than be part of an electronic referral and international quality control network, so on the face of it there would be little or no interest from Optometrists in this service. I am perfectly prepared to accept that I am completely wrong, its has happened once before, and I would be absolutely delighted to hear from anyone who would want to engage in a meanignful discussion about how we could address these issues.

    Feel free to post a reply or e-mail me directly at gns-at-digital-healthcare.com. Who knows, maybe we can figure out a way to make it better for all of us.

    Yours in peaceful co-existence

    Gerry Skews
    Digital Healthcare


  3. Gerry,
    I appreciate you addressing these issues, and it’s not lost on me that your organization seeks out conversations with blogs like this one. I’m just another optometrist in the trenches, but I do have significant experience managing diabetic eyecare with my work in the Indian Health Service.

    If your legal team says the images sent to the reading center have to be interpreted by OMDs, I guess that’s not my chief complaint. There can only be a small number of doctors hired for this job, so it won’t effect optometry in general. (Although in the Indian Health Service model, there are optometrists and ophthalmologists at Phoenix Indian Medical Center who read the digital photos.)

    My concern is that after any sign of retinopathy is seen in the digital photo, referrals are generated only to ophthalmologists . This does effect optometry in general. A patient who normally comes to me before their diabetes diagnosis would now be told they should be seen by an OMD.

    Just as the majority of primary eyecare is performed by optometrists, then I would expect the majority of referrals generated by your readers would be sent to optometrists.

    I feel it’s just plain discrimination, and I won’t be happy until your company policy and website state that referrals can be made to “eyecare provider” or “optometrist or ophthalmologist.”

  4. Amanda Green says:

    I’m interested to hear your opinion on Retasure for low percentage of adequate health insurance coverage. I am doing a bit of research on behalf of a community health center, and their patient profile is about 55% uninsured, and many of their patients are diabetic.
    You seem to have mixed feelings about it in your original blog – but do you think it is a worthwhile investment: health benefit to cost and potential sacrifice of regular eye exams?

    Thanks for any input!

  5. I think that people need a full eye exam, not just a picture of one part of their eye.

    I think the 55% of your patients who are uninsured should do what most people without vision/medical insurance do: go to their nearest Wal-Mart optometrist and get a dilated comprehensive eye exam for around $55.

    I still believe telemedicine such as this should only be used in the extreme cases where you are trying to simply screen a large quantity of people at once and/or the patients are prohibitively far away from the nearest eye doctor (not as big of a problem as it used to be).