Tele-Ophthalmology Update

Brings Care to Medically Under-served Michiganders

Routine eye examinations are vital to prevent vision loss from common, treatable eye diseases. But some people, notably seniors and the economically disadvantaged, are less likely to seek eye care, for many reasons including poor access to reliable transportation and a lack of local services.

A new care delivery model called Technology-based Eye Care Services (TECS) helps patients overcome these barriers. After a highly successful pilot in and around Atlanta, Georgia, the tele-ophthalmology platform is expanding into Michigan.

How TECS Works

A trained ophthalmic technician is stationed in a primary care clinic away from the main hospital. The technician follows a detailed protocol to take measurements of the patient’s eyes, and patients are fit for eyeglasses. The information collected in the exam is electronically transmitted to an eye provider at the main hospital, who interprets the data remotely. Patients with abnormal findings are scheduled for follow-up care at the main hospital’s eye clinic, and help is available to get patients to these appointments.

April Maa, M.D., TECS clinical director, is an associate professor in the Department of Ophthalmology at Emory University School of Medicine and also an adjunct associate professor of research at Kellogg. Dr. Maa led the team that, in 2015, created TECS in partnership with five primary care clinics associated with the Atlanta Veterans Affairs Medical Center.

In the first 13 months of TECS operation, nearly 2,700 patients received eye care. Six quality and satisfaction metrics were recorded, and the results were impressive. “TECS was shown to be a win-win for providers and patients,” Dr. Maa says.

TECS in Michigan

With support from the VA Office of Rural Health, TECS now provides eye care to veterans at 20 sites in seven states. Eight more VA hospital hubs are slated to launch TECS in 2020, including the Ann Arbor VA Health System.

Maria Woodward, M.D., M.S., assistant professor, co-directs Kellogg’s eHealth programs and serves as the site director for TECS at the Ann Arbor VA.

“It’s been exciting to watch the TECS success story unfold,” says Dr. Woodward. “We could see it would be a great tool to better serve our Michigan veterans. The Ann Arbor clinic location is up and running, and we’re expanding to other medically underserved parts of the state.”

Expanding Glaucoma Screening With TECS

The TECS approach may also help expand access to specialty screening for high-risk populations.

Kellogg glaucoma specialist and co-director of the Kellogg Center for eHealth, Paula Anne Newman-Casey, M.D., M.S., is leading a pilot program funded by a grant from the Centers for Disease Control and Prevention to screen individuals at increased risk of primary open-angle glaucoma. Although just 2 percent of the U.S. population has this condition, it’s still a top cause of irreversible blindness, particularly among African Americans and low income individuals.

It will be the first time the fundamentals of TECS will be applied to a population other than veterans.

“My experience volunteering at free screening events showed me that we’ve been approaching the challenge the wrong way,” says Dr. Newman-Casey. “We disproportionately screen low-risk individuals, and when we do identify a patient with glaucoma, we leave too many barriers to follow-up care unaddressed.”

Two clinics serving low income populations, the Hope Clinic in Ypsilanti, Michigan, and the Hamilton Clinic in Flint, Michigan, are partnering with Kellogg for the trial, Screening and Intervention for Glaucoma and eye Health through Telemedicine (SIGHT). Technicians will perform screenings in the community clinics and transmit the data to an ophthalmologist at Kellogg for interpretation. Follow-up appointments and transportation will be coordinated for patients as needed.

The pilot program incentivizes participation in glaucoma screening with low-cost glasses and includes access to education and help obtaining follow-up care. The program will also test whether personalized education and counseling improves followup adherence compared to standard education.

“We’ve tried to address every key logistical and psychosocial barrier to screening and care, including cost, transportation, mistrust of providers, and skepticism that a disease with no symptoms can lead to blindness,” says Dr. Newman-Casey. “We’re excited to see if we can improve outcomes for at-risk individuals in our area and create a roadmap for expansion to other communities.”

The Next Frontier: Tele-Genetics

There are about 30 genetic counselors devoted to inherited eye diseases serving the entire United States. Kellogg is home to two of them.

To expand access to this rare specialty, Kellogg is exploring partnerships with ophthalmologists outside of southeast Michigan with patients in need of genetic counseling.

The aim is to use videoconferencing to link patients and family members with Kellogg genetic counselors Kari Branham, M.S., C.G.C., and Dana Schlegel, M.S., M.P.H., C.G.C. Remote counseling could take place prior to genetic testing to gather family histories and discuss the risks, benefits and limitations of testing. After genetic testing, the same remote approach could be used to explain the diagnosis of an inherited disease, explore potential risks to other family members, or discuss whether experimental genetic treatments might be available.