More than 30 million Americans have been diagnosed with diabetes.¹ But less than 50% of diabetic patients get annual eye exams to screen for indications of diabetic retinopathy or disease advancement.² Approximately 1 in 3 patients dealing with diabetes will experience some level of diabetic retinopathy.³

With these facts and figures in mind, Zeiss created the Velara Teleretinal Screening System, which can be used in nontraditional eye-care settings, such as primary care provider offices. This can help improve compliance rates for diabetic patients, close care gaps, and help patients avoid preventable blindness. It also supports one of the company’s goals to help eye care providers, including retina specialists, maximize their efficiency by seeing the right patient at the right time.

“There are a variety of reasons why patients don’t go to an eye doctor for screening, such as not understanding the importance of screening, a lack of access to a nearby eye doctor, difficulty with transportation, or a busy work schedule,” says Richard Lin, MD, PhD, a retina specialist at Scripps Clinic in San Diego, California, who has started a pilot program at Scripps to place fundus cameras in primary care clinics. Dr. Lin reads and grades the images taken at clinics.

AN INNOVATION IN SCREENING

Screening solutions aren’t a new concept, but there have been several challenges with previously deployed solutions that have limited their effectiveness, according to Zeiss. For example, handheld cameras have been a popular option for screening for their portability and small footprint. However, they can be difficult to use for nonophthalmic personnel, potentially reducing an image’s quality and gradeability. Another common issue has been a lack of data connectivity; if data do not flow seamlessly from one provider to another, the results may not be documented appropriately.

In contrast, Zeiss’s Velara leverages an automated fundus camera to ensure high-quality images regardless of a technician’s skill level and relies on a fully connected workflow, ensuring that images and reports are transmitted seamlessly without relying on manual data entry.

Dr. Lin explains that Velara’s camera takes a photograph of the optic nerve and macula through an undilated pupil. The photographs are uploaded onto the Zeiss portal via an app, which he accesses remotely. He then reviews images for pathology, enters the results into the grader app, and communicates results to primary care providers.

Dr. Lin notes, however, that using Velara for screening is not as good as a complete dilated eye examination, and patients should see an eye doctor in person if they experience unusual vision symptoms or vision loss.

INCREASING COMPLIANCE

Nathan Kiskila, MD, president and primary care physician at Marque Medical in Irvine, California, says the Velara system is another tool in his armamentarium to offer to his patients. “Instead of advising a patient to see an eye doctor, I can obtain images in my office in 5 minutes, which increases compliance,” he says.

Using the Velara system, Dr. Kiskila has detected pathology in 30% of the patients he’s screened. Almost every patient he recommends screening to complies. “When a patient is told they have an eye issue, they are much more likely to see an eye doctor,” he says.

The Velara can also be used to screen for macular degeneration, retinal vascular occlusions, optic neuropathy, suspicion of glaucoma, and suspicion of cataracts. It cannot detect peripheral retinal pathology such as a peripheral retinal tear or detachment. “The ability to detect retinopathy or other conditions also depends on a photograph’s quality,” he says. “Most of the photographs have been quite good, but some may not be able to be graded due to dense cataracts, small pupils, or another reason.”

In addition to diabetic patients, Dr. Kiskila screens patients who report pain or blurriness. “Many adolescents have computer vision syndrome from using the computer all day while schooling from home,” he says. Screen time in this population has increased precipitously since the COVID-19 pandemic began.

EASE OF USE

According to Dr. Kiskila, the Velara is easy and comfortable to use. “You don’t have to dilate a patient’s eyes, administer drops before using it, or squirt an uncomfortable air puff into the eye,” he says. “Patients simply place their heads in the head rest, and the camera automatically aligns and captures the image.”

The Velara sits on a counter or desktop; it’s easy to pick it up and move if needed, Dr. Kiskila says. Users are medical assistants, not specific to ophthalmology, and they’re easy to train. In addition, Zeiss works directly with IT teams to connect the Velara to EMR systems and cloud-based software and also provides online training workshops.

The Velara system’s camera is driven through a tablet, so it enables operators to be positioned however they’re most comfortable and enables social distancing where required, according to Zeiss. Grading providers can access the software anywhere because it is cloud based.

As a physician who reviews images, Dr. Lin says the grader app is easy to use. “It only requires a few button clicks per patient,” he says. “There are prepopulated buttons for grades of diabetic retinopathy, macular edema, and other common conditions such as cataracts, glaucoma, and macular degeneration. It’s fast to enter results.” RP

REFERENCES

1. US Centers for Disease Control and Prevention. Type 2 diabetes. Accessed January 17, 2022. https://www.cdc.gov/diabetes/basics/type2.html
2. American Academy of Ophthalmology. Sixty percent of Americans with diabetes skip annual sight-saving exams. Accessed January 17, 2022. https://www.aao.org/newsroom/news-releases/detail/sixty-percent-americans-with-diabetes-skip-exams
3. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic eye disease. Accessed January 17, 2022. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease