Project I See in NC: Initial results of a program to increase access to retinal examinations among diabetic individuals in North Carolina.

Abstract

Diabetic retinopathy is the leading cause of preventable blindness in adults. Project I See in NC was begun to determine whether access to eye screening for Medicaid recipients and uninsured patients with diabetes in North Carolina could be improved. We targeted Medicaid recipients and uninsured adults with diabetes for screening in 2 Community Care of North Carolina Networks. Screenings were performed in primary care settings throughout 6 counties in the Northwest Community Care Network and 6 counties in Access III of Community Care of the Lower Cape Fear. Patients were screened using a high-resolution digital retinal camera with images read at a centralized reading center at Wake Forest School of Medicine. A total of 1,688 patients were screened from October 2005 through September 2007. Nearly 15% (282) were found to have mild, nonproliferative-to-proliferative retinopathy, while the majority of patients had no evidence of diabetic retinopathy. Nearly 12% (196) required referral to an ophthalmologist, with 5% (86) requiring urgent referral for potentially sight-threatening retinopathy. We were not able to confirm which patients kept their ophthalmologic appointments; however, we are currently analyzing data from the Medicaid patients in our study who required ophthalmologic referral. Remote digital retinal screening for diabetic retinopathy is feasible in primary care settings in both urban and rural areas of North Carolina, and it may prove to be an effective means of reaching more patients who require annual screening examinations.