By Jan Orvik

Imagine being able to diagnose diseases such as diabetes as quick as the click of a camera.  That painless snap of the shutter results in a comprehensive picture of the eye’s interior that allows physicians and ophthalmologists to detect diabetic eye disease and track its progression.  They can even find infections and diagnose other conditions, including macular degeneration, detached retinas, and macular edema.

RIGHT : Digital photographs of the retina offer a quick, painless and convenient way to diagnose the health of the eye, to monitor the effectiveness of treatments, and to consult with medical specialists anywhere in the nation. 

This technology, known as remote retinal imaging, is available to residents of the Turtle Mountain Indian Reservation.  A second camera travels around the state.  Funded by Congress, the project has increased early diagnosis, helped physicians better educate patients, and increased the numbers of patients who are screened for diabetes.  Plus it saves time, money, and travel for both patients and physicians.  The images of the eye can be transmitted to experts around the nation, allowing quicker diagnoses and reducing the need for patients to travel.  And because the procedure is fast and painless, patients are more likely to return for checkups.

Telemedicine is a boon for rural states such as North Dakota, says Robert Rubeck, director of the Health Information Technology Initiative at UND’s School of Medicine and Health Sciences.  Rather than requiring patients or physicians to travel long distances, telemedicine moves information between them.  Digital medicine allows the capture of medical findings at a lower cost and makes tracking patients and conditions easier. 

Rubeck and others initiated the telemedicine project at Turtle Mountain as part of a response to the large volume of complex health problems typically found on American Indian reservations.

“It’s a heartbreaker to see people go blind from diabetes,” he said.  “We wanted to find a way to diagnose diabetes early, educate patients, and intervene to prevent blindness and other complications.”  This “focused intervention” allows instant diagnosis, so optometrists and physicians can educate patients and families about ways to prevent diabetes or slow its progression.  Before the advent of the digital eye camera, Rubeck said, patients often failed to return to the clinic to receive test results.

Diabetes affects the eye by causing it to grow new blood vessels that eventually cover the retina, resulting in blindness.  Doctors can now cauterize these vessels before they spread and destroy vision.  Regulating blood sugar through diet and exercise can prevent or delay this and other conditions.  The new camera tracks the progress of the eye disease, and its photos help patients to see how changing their behaviors can slow diabetes and prevent or delay complications.

In one case, Rubeck said, the camera saved a man from having to receive a second spinal tap, a procedure that’s both painful and expensive.  “He was suffering from a neurologic infection,” Rubeck said.  “We could see its manifestation in his eye, so we snapped pictures of it to determine whether the antibiotics were working.”  They e-mailed the photos to a neurologist, who tracked the infection as it resolved, saving pain, money, and travel.

The camera is operated by Terry Schleisman, an optometrist at the Quentin N. Burdick Memorial Health Care Facility eye clinic in Belcourt.  Before the advent of the digital eye camera, many diabetics deferred their yearly eye examinations.  Now, nearly all come in for their annual screening.  Using a secure server, the optometrist transmits the images to retinal specialists in Fargo and elsewhere for diagnosis.  The images can be visually manipulated to better diagnose specific conditions.  The same technology can also safely transmit x-rays and medical records, allowing specialists to diagnose conditions at a distance. 

Patients like the procedure because it’s quick and painless, and doctors like it because it’s easy to use, makes diagnoses more accurate, and allows them to easily measure the progress of a disease and determine patient effectiveness.