A technological and
to improve detection of
target organ damage
S. Naidu, MD, MPH, FAAFP
Oklahoma Community Health Services, Inc.
Payer Mix in Study Group
– Improve screening of patients for diabetic
– Evaluate the need for an affordable
program to implement retinal screening in
– Determine and document underlying
disease in an unevaluated population.
Oklahoma Community Health Services
(OCHS) has a diabetic population of 862
and is a participant in the National
Diabetic Collaborative program. The
diabetic population is 64% uninsured
and has only 5% covered by commercial
A pre-intervention chart audit was conducted on all
diabetic patients within OCHS. Data regarding
baseline ophthalmologic evaluations were collected.
Every diabetic patient was invited by letter and
telephone to participate in the study and undergo
retinal imaging. Over a period of one month, 365
patients were enrolled for free iScan screening.
The chart audit revealed baseline
compliance of 4.5%. The iScan intervention
over a period of one month bolstered
compliance to 42%.
No ME ME not CS MHE CSME CE
No ME 302 2 2 5 8 319
ME not CS 1 1 2
MHE 3 3 1 1 8
CSME 2 2 7 5 16
CE 5 2 13 20
310 5 9 14 27 365
302 patients (83%) had normal retinal scans; 60 (16%)
received recommendation for referral to ophthalmology. Of
those 60 patients, 8 (13%) were referred for macular hard
exudates, 18 (30%) for clinically significant macular
exudates; and 34 (57%) for poor image quality or cataracts.
1. Since the cost of the iScan usually represents 30%
of the cost for ophthalmologic referral, the
intervention resulted in an enormous conservation
of financial resources, revealing a large proportion
of diabetic patients with normal retinal scans.
2. The intervention dramatically improved diabetic
retinal screening in a short period of one month.
3. The need for a cost effective, efficient modality for
diabetic retinal screening was dramatically
1. Clinics with restricted resources often do not have affordable
programs to screen for diabetic retinopathy, and this
program allows for tremendous savings since a large
proportion of patients had normal retinal screening.
2. The iScan retinal imaging program is high-quality,
convenient, and cost-effective in bringing affordable
technology to provide essential screening for diabetic
retinopathy, leading to early intervention, improved
outcomes, and avoidance of expensive and invasive
3. Implementation of this cost-effective technology has
enhanced the detection of disease and increased the referral
rate to ophthalmology for appropriate disease-specific
patients. This still resulted in tremendous savings to the
system as the retinal screening was already completed.
4. This technology offers a novel approach to develop new policy
for retinal screening within the health-care setting. An
additional opportunity exists for multiple facilities in close
proximity - to cost-share - making this a viable program.