Eye exam could prevent blindness

More than 18,000,000 Americans have diabetes, yet over half of them do not receive the annual retinal exam that helps prevent diabetic retinopathy, which can lead to blindness.

"Many people go blind needlessly because their retinas never are examined on time," laments Michael Abramoff, assistant professor of ophthalmology and electrical and computer engineering, University of Iowa, Iowa City. "lf you diagnose diabetic retinopathy early in a patient, you can treat it very well. But many individuals with diabetes do not have access to an ophthalmologist because of distance or other difficulties and do not get an annual exam."

Currently, a routine eye exam involves having one's pupils dilated, and the analysis is done at the ophthalmologist's office. With travel time, a rural patient might spend up to half a day getting an exam. In many areas, there is no ophthalmologist within 50 miles. "Even if ophthalmologists did nothing but give annual eye exams to people with diabetes in the U.S., there still would not be enough doctors to provide all the needed exams," observes Abramoff.

To overcome these hurdles, Abramoff and his collaborators are developing ways for family or internal medicine physicians to use digital cameras to take pictures of patients' retinas. The photos can be taken in 10 minutes, much more quickly than a typical eye exam. Because diabetes damages small blood vessels in the eye, pictures can be analyzed for the small hemorrhages and signs of fluid that, if left untreated, lead to blindness. The photos are sent electronically to eye experts who determine if danger signs are present and inform the patient's doctor for appropriate follow-up care. The cameras already are being used on a small scale.

However, the digital camera needed currently costs $30,000-$50,000, making it extremely difficult for most family or other primary care physicians to have the device in their office. Abramoff is working to develop an appropriate digital camera that would cost about $2,000. If he succeeds, many more patients with diabetes could receive the timely checkups they need.

"We've developed a prototype for the camera," Abramoff reports. "It's complex technically, but uses parts that are easily available, such as components normally found in DVD players and bar-code scanning devices."

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