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EW RETINA 124 March 2017 diabetic retinopathy is no longer the leading cause of blindness in working-age adults, but that has since been replaced by glaucoma. "This has utterly changed the scope of the problem in that country," she stressed. However, Dr. Charles points out that in some areas of the world where vision loss due to diabetic ret- inopathy is high, simple screening measures alone would have little im- pact. In such areas, the real problem is not just discovering cases of dia- betic retinopathy but also treating these, he observed. "Laser requires a high skill set, so you can't hire nurs- es to go do the laser," Dr. Charles said, adding this hopefully requires ophthalmologists with a retinal background. What's more, this is not even as effective as anti-vascular endothelial growth factor injections, which in many cases are extremely pricey. "What are the logistics of taking people in Sub-Saharan Africa or rural India for treatment?" Dr. Charles asked. He views this as a more difficult barrier than screening to ultimately overcome in striving to preserve vision in diabetic retinopa- thy cases worldwide. EW References 1. Leasher JL, et al. Erratum. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: A me- ta-analysis from 1990–2010. Diabetes Care. 2016;39:1643–9. 2. Lu Y, et al. Divergent perceptions of barriers to diabetic retinopathy screening among patients and care providers, Los Angeles, California, 2014–2015. Prev Chronic Dis. 2016;13:E140. 3. Lu Y, et al. Disparities in diabetic retinopathy screening rates within minority populations: Differences between African American and Hispanic patients. Diabetes Care. 2015 (epub ahead of print). 4. Valikodath NG, et al. Patient attitudes toward telemedicine for diabetic retinopathy. Telemed J E Health. 2016 (epub ahead of print). Editors' note: Dr. Woodward has financial interests with the National Eye Institute (Bethesda, Maryland). Drs. Charles and Ipp have no financial interests related to their comments. Contact information Charles: scharles@att.net Ipp: ipp@labiomed.org Woodward: mariawoo@med.umich.edu multiple health issues and wanted to streamline their care, this also was enticing. On the other hand, those with long-standing diabetes, involving entrenched routines or strong relationships with their eye practitioners were less likely to want to participate, she noted. In the United States, however, such a telemedicine system faces some clinical obstacles. "The biggest barrier that we have in the United States is the lack of comprehensive coverage of services," Dr. Woodward said. "This is the way that every sin- gle diabetic in the United Kingdom is screened, the way every veteran is screened at Veterans Health Ser- vices, and also every person served by Indian Health Services." When there are comprehensive policies, it just makes sense to take such a patient-centered approach instead of bringing people in separately for an eye exam. But when you have many different providers, the reimburse- ment can be difficult to set up, she explained. "We need to make policy chang- es because this approach benefits our patients," Dr. Woodward said, adding that in the UK after imple- mentation of telemedical screening, Dialing continued from page 123 Are you a fan of EyeWorld? Like us on Facebook at facebook.com/ EyeWorldMagazine

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