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Visions of the future: treating retinopathy from afar

March 26, 2014

Goodbye to long waiting times to visit the ophthalmologist in Eeyou Istchee, and equally long waiting times to receive results. The Cree Health Board’s new tele-ophthalmology screening program means that patients will be able to have their eyes checked for diseases like retinopathy at their local CMC and will receive the results from the screening in just four weeks, informing them whether they need treatment. The program is a boon for patients suffering from diabetes, for whom vision loss is a real threat. 

“We have an ophthalmologist who visits every community but we have too many people needing appointments,” says Caroline Allard, the Cree Health Board’s nurse in charge of telemedicine. “So we decided to begin remote screening for retinopathy to ensure that diabetic patients do not have damaged retinas.” The retina lies at the back of the eye, where it catches light that is transmitted into signals to be sent along the optic nerve to the brain, allowing us to see. Retinopathy, or disease of the retina, can be caused by high blood sugar, which damages the tiny blood vessels that allow the retina to function. People with diabetes are especially vulnerable to this condition, which can lead to blindness.

The screening process begins with the patient having some visual tests to ensure that the treatment is appropriate for them. Then the nurse will put drops in each eye, first to “freeze” the eye and then to dilate the pupil so that the retina can be photographed. Once the pupils are dilated, the CHR uses a specialized camera to take several photographs the patient’s retina; these images are then sent online to Dr, Michael Quigley, a Montreal-based specialist with RUIS McGill, who will return test results in four weeks, or even sooner if the CHB team flags any images as showing signs of retinopathy (which shows up as small dots on the image). If all is well, the patient can rest easy until the next scheduled visit; if not, they will find out quickly in order to receive prompt treatment in Val d’Or or Montreal. “The program allows us not just to determine who needs more care, but also screens people to make sure we catch in advance if they have something,” says Allard. It also offers a substantial improvement over treatment received in the south, where patients can wait up to two years for this kind of screening.

For several months, beginning early in the winter and scheduled for completion in the coming summer, training sessions have been rolling out across Eeyou Istchee to ensure that CHRs and nurses are able to operate the equipment. So far more than 200 people have been tested, and the reviews are very positive. “Patients are happy to have the tests because they know there are long waiting lists in Montreal and Val d’Or. These tests are an opportunity to give them faster follow-up to prevent blindness,” says Francine Noel, the nurse in charge of training personnel on the new equipment. “The test can detect people who had retinopathy and don’t even know it. Two people took the test, and it was a good thing, because now they are receiving treatment to save their vision.”

Currently Noel is training CHRs to use the equipment, take the pictures, send them to specialists and bring back the results. After three days training on equipment, the CHRs, with Noel as a supervisor, spend another two to three weeks seeing patients and honing their skills on the equipment. Next, nurses in each community will be trained to dilate patients’ eyes so that pictures of retinas can be taken. When the program is fully installed, patients will be able to drop into their CMC for their screenings.

The tele-ophthalmology program is the first telemedicine program in Eeyou Istchee, but it won’t be the last. The recent installation of fibre optic cables in five communities has improved the Cree Health Board’s capacity to send data to specialists in southern facilities, which means that new telemedicine initiatives can be launched. Psychiatry and speech therapy are soon to be added to the telemedicine roster, along with initiatives that will see non-stress-tests for pregnant women and echocardiographs to assess heart conditions being performed remotely. Programs in tele-nephrology, and tele-dermatology are also being planned.

tele-ophthalmology trainingDiabetic retinopathy imager training at Chisasibi hospital, with CHR Christopher George, Cherubine Martin, Nurse Consultant Francine Noel, CHR Lisa Bobbish and Annie Dussault from RUIS McGill