Abstract: TH-PO730

Use of Fundus Photography in the Dialysis Facility to Screen for Diabetic Retinopathy

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Garza, Greg S., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Martin, Michael P., Fresenius Health Partners, Austin, Texas, United States
  • Richmond, Chris, Fresenius Health Partners, Austin, Texas, United States
  • Aronson, Andrew, Fresenius Health Partners, Austin, Texas, United States
  • Radonova, Maria, Fresenius Health Partners, Austin, Texas, United States
  • Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Ketchersid, Terry L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Diabetic retinopathy is a leading cause of vision loss in the United States and 2 times more prevalent in kidney disease patients (Varma 2014; Ricardo 2014). Through the Comprehensive ESRD Care (CEC) Model, Fresenius Medical Care North America has partnered with CMS to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with ESRD. We aimed to increase preventative retinal exams that diabetic end stage renal disease (ESRD) patients receive. We are obligated to disclose that the statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Methods

We implemented a preventative retinal exam initiative at one Fresenius Kidney Care (FKC) dialysis clinic. Claims data was utilized to identify patients diagnosed with diabetes (Type 1 or Type 2). Eligible patients were invited to have fundal eye examinations performed in the dialysis facility. The exam was ordered by the nephrologist and administered by nurses in the Care Navigation Unit. Photography results were transmitted in a HIPAA compliant fashion to be reviewed and interpreted by a board certified ophthalmologist. The interpretation of the retinal exam was uploaded into FKC’s electronic medical records for nephrologist review.

Results

We identified 27 diabetic patients who were eligible for retinal screening. 22% had successful images captured without the need for pupil dilation. For those who did not obtain a successful eye exam, reasons were: Presence of cataracts (<30%), anxiety (<10%) or small pupils (<25%). Ophthalmologists reported the interpreted results within 90 minutes.

Conclusion

Introduction of this device may yield favorable retinal exam screenings in greater than 20% of the eligible diabetic population without pupil dilation. Counseling to reduce anxiety and the use of mydriatics may improve the proportion of successful retinal exam screenings.

Funding

  • Commercial Support