Bringing free retinal screenings to Remote Area Medical clinics

The identifeye HEALTH team is proud to collaborate with Remote Area Medical (RAM) to bring free retinal screenings to underserved communities as part of RAM’s free healthcare clinics.

We have participated in four RAM clinics so far, and continue to be impressed with the breadth of services provided, the thoroughness of planning and organization, and the dedicated volunteers and RAM staff. Most inspiring of all are the patients, many of whom travel long distances and arrive well before dawn to access care.

Portable screening that fits the clinic

RAM pop-up clinics provide an impressive array of services: medical, dental, and vision care, including prescription glasses made on-site. At the clinics we support, identifeye HEALTH adds portable retinal imaging to help clinicians identify patients who may need further evaluation.

Our retinal imaging cameras fit in a suitcase, can be set up on a small table, and can be quickly moved from room to room to adjust to patient volume and clinic workflow. With almost no training, other RAM volunteers can run exams and help capture retinal images, expanding the team’s capacity to screen patients. The identifeye HEALTH web-based portal allows on-site eye care clinicians or remote volunteers to review patient images in real time and flag potential issues for patient follow-up.

Why screening early matters

Not every RAM patient makes it to the Vision area, since appointments are limited and the wait can be long. For patients with diabetes and high blood pressure, skipping their annual eye exam increases their risk of vision loss due to diabetic retinopathy, hypertensive retinopathy, and other eye diseases associated with chronic illness.

A study using 2017 US data estimated that 93 million adults are at high risk of vision loss; approximately 40% of them have not had an eye exam in the past year.¹ ² Diabetic retinopathy affects 1 in 3 patients living with diabetes.³ Over four million adults in the US have glaucoma, the leading cause of irreversible blindness worldwide, with people from racial and ethnic minority groups disproportionately affected in the US.⁴ RAM brings healthcare services to underserved communities, where patients face multiple barriers to accessing routine eye care: cost, availability of specialists in more remote areas, and lack of awareness.

To help address this gap, we screen patients at the start of the RAM clinic workflow, and doctors review their images right away. It takes some legwork from the volunteers, but we make sure that patients who need to be seen by an eye care provider are found and directed to Vision services. We also provide retinal screenings to all patients already in the Vision clinic, so they get a more comprehensive eye exam.

Findings flagged by clinicians reviewing these images have included signs concerning glaucoma, diabetic retinopathy, and retinal vascular changes that may be associated with hypertension. These findings can prompt further eye evaluation and, where appropriate, follow-up with a primary care clinician.

Four clinics, 446 exams

Each clinic typically runs for two days, starting at 6am. All the volunteers are focused on providing care to as many people as possible in that limited time, making for an intense but very rewarding couple of days. Across these four clinics, we conducted 446 retinal exams and recorded 98 referrals for follow-up. The Pahrump, NV clinic offered an additional benefit for returning patients this year: clinicians could compare retinal images captured with the identifeye System at last year’s clinic with this year’s images, to assess changes over time.

These are just some of the more than a thousand patients screened with the identifeye System in the US and internationally. Identifying a concern is only the first step. Patients who are referred for follow-up need to be connected with affordable, accessible specialist services. This continues to be a challenge, especially in underserved communities.

RAM volunteer clinicians and staff work with patients to explain the need for follow-up and connect patients with available resources. Our experience with these clinics reinforces the importance of building pathways from screening to evaluation and treatment, so that earlier identification can translate into care.

If you would like to support RAM’s work, please visit ramusa.org. You can donate, volunteer at a clinic (healthcare providers are always in demand), or explore hosting a clinic in your community.