You may already know about LAB’s “Horizons”, which is broadcast on the radio reading service and highlights people and programs of interest to the blind and visually impaired community. You may also be aware of LAB’s VOICE program, an exciting, grant-funded initiative that is furnishing qualified consumers with a chance to gain direct experience in producing and recording shows for our radio station. Combine these ground-breaking efforts and what do you get? An hour-long show by Steve Bears, the first graduate of our VOICE program, that focuses on enhancing services to people with diabetes.
This condition is quickly becoming one of our country’s greatest health challenges. Today, one in ten Americans has diabetes. However, if nothing is done to put a damper on the current progression, one in three will have it by 2050. One of the best ways to ensure that the trend is slowed is preventive care, both to avoid becoming diabetic in the first place and to minimize the complications once it has been diagnosed.
Along with kidney and circulatory problems, diabetes frequently causes damage to the eyes, specifically the retinas. As blood sugar levels rise and circulation is affected, the eye becomes starved for oxygen and blood vessels die. To combat this, the body creates new, fragile ones that often break, causing bleeding. In the most severe cases, particularly when preventive measures have not been taken, blindness can result.
Recognizing this fact, specialists at New England Eye, Network Health, and Neighborhood Diabetes have begun to collaborate on a pilot project. Several of them sat down with recent VOICE Program graduate Steve Bears to discuss the initiative. They included Dr. Pano Yeracaris, the Vice President and Chief Medical Officer at Network Health, Dr. Gary Chu, Vice President of Community Collaborations and Associate Professor at New England Eye, and Elizabeth Bean, a Quality Specialist at Network Health.
Steve began by obtaining some fascinating information about Dr. Yeracaris’s background. After spending 28 years in a family practice, he decided to change his career focus. To this end, he came to Massachusetts and obtained a Master’s degree in public health from Harvard. Much to the gain of the Bay State, he decided to move here permanently. The next several years of his life were spent working in community health centers in Dorchester. Then, eight years ago he took his current position at Network Health. “It’s been an exciting time to be here in Massachusetts both with all the opportunity for innovation and bringing in healthcare reform both in 2006 and now with all the changes that are occurring,” he enthused. Dr. Yeracaris is also on the Board of the New England College of Optometry, which is the parent company of the New England Eye Institute. Both in his direct practice and his work at Network Health, he has long been interested in improving services for people with diabetes in order to prevent the complications that can make this disease so difficult. In Massachusetts alone, 215,000 Network Health members have been diagnosed with this condition.
The challenge that makes diabetic care daunting is that patients frequently have a hard time getting to their appointments. And when it comes to eye check-ups, many are reluctant to have the full exam, since it includes dilation and makes it harder for them to see for a period of time afterwards. That is where Dr. Chu and the New England Eye Van come into the picture.
In recent years, thanks to the tireless work of Dr. Chu and his associates, the Eye Van has traveled throughout the state, making it much easier for people to obtain eye and low vision testing. During this same time period, the Veterans Administration has implemented a mobile eye screening program, distributing about 600 cameras to veterans’ centers across the country. Why not use this type of mobile model to enable diabetics here in Massachusetts to get full retinal screenings? At the moment that Dr. Yeracaris and Dr. Chu asked that question, the Mobile Eye Van for diabetics pilot project was born.
Thanks to the wonders of modern technology, it is now possible to look at both the front and the back of the eye with the traditional slit lamp and to take images of it using a digital camera. Right in the mobile van within seconds, a patient can actually look at his or her retina and see how diabetes is affecting it. If it so happens that a lot of bleeding is occurring, the patient can be immediately referred to a specialist. In addition, these images can pinpoint other serious eye conditions including macular degeneration, cataracts and glaucoma.
The van also boasts another technical advancement that gives the patient and his or her doctors further insight into diabetic management. With a simple finger stick, the patient can receive an A1C hemoglobin test. After a brief, ten-minute wait, this test provides data that reveals how the body has been processing sugar over the past 90 days. Although it is only a snapshot, it gives a better idea of a person’s ability to manage diabetes than does a simple glucose check. That information, combined with what has been learned during the eye screening, allows for a much more detailed picture of a patient’s overall diabetic health. It is sent to the primary care physician, who can then discuss further treatment options with the patient.
Dr. Yeracaris expressed a great deal of excitement about the potential growth of this project. Once funding has been secured, he can even imagine it going directly to people’s homes, making it even easier for them to access services. “It is hard to reach folks,” he explained. “We do find in our population a lot of people’s phone numbers are incorrect, up to a third. Of the people we do reach, there certainly is a good response and an interest. But then getting us to get people scheduled to come at a specific time and in a specific place is a little bit more challenging. So I think we’ll need to put our heads together and look at the lessons learned. I’m committed to trying again and having us see what we can do to improve our capture rate.”
He also cautioned that this mobile service should not be seen as a replacement for receiving a comprehensive eye examination from an eye care professional. Instead, it is a screening tool designed to monitor diabetic care and alert patients and their physicians to possible complications.
The outlook for this project’s future seems bright. While it is in its infancy now, similar initiatives in the United Kingdom have become the standard of care throughout the country. Here in the US, the VA’s efforts have also been very successful. Although long-term funding has not yet been found, Dr. Yeracaris stated that Network Health would cover the cost of reading the retinal image. The cameras that are now being used on the van are on loan for several more months, enabling project co-coordinators to have some time to come to decisions about their next move.
It seems clear that the Eye Van is moving diabetic care in the right direction. For Elizabeth Bean, this couldn’t be better news. Her focus is on ensuring that Network Health members receive the highest standard of care and that it is within state and federal quality guidelines. One of these standards involves providing eye examinations to patients with diabetes. The Eye Van provides an innovative way to help patients obtain the care they need and are currently often unable to receive.
One additional reason for the success of mobile diabetic eye screenings was described by Dr. Chu: “What the VA has been finding is when an individual sees the image of their eye because that’s the only place that you can see live blood vessels, . . . things begin to click (regarding) the importance of controlling blood sugar. So that adds value to this.” Combine that with the benefits of the A1C hemoglobin test, and it is no wonder that all of these health specialists are singing the praises of this project.
Who is eligible to benefit from this mobile diabetes eye van? Patients must be Network Health members through Mass Health. In most cases, Network Health will contact members who have been diagnosed with diabetes, particularly people who have found it difficult to comply with treatment goals. Conversations will focus on ways to enhance health and improve diabetic management, and the mobile eye van may be an option. If you are a Network Health member and have further questions about how this program might benefit you or someone you know, call them at 1-888-257-1985. Their website is
If you have been diagnosed with diabetes and would like a quick, informal way of checking for visual changes, Dr. Chu recommends that you cover one eye and focus on something very specific with the other such as a word on a piece of paper. If it looks wavy or if parts are missing, you should visit your eye care professional. Thirst, vision fluctuation and frequent urination are potential signs that you may have diabetes. “If I can have the listeners remember anything, it is understanding the importance of diabetic education . . . and of nutrition,” Dr. Chu concluded. In the years to come, the New England Eye van might well be at the forefront of giving patients the knowledge and personalized information they need to better manage this challenging disease.