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Chickasaws create new 'gold standard' in preventing blindness

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ADA, Okla. ? The Chickasaw Nation has its own astronaut. Now, in partnership with the Inoveon Corporation, it is introducing a new way to preserve the eyesight of diabetics.

Implemented two years ago at the tribe's Carl Albert Indian Hospital (CAIH), the system is designed to facilitate the diagnosis and treatment of diabetic retinopathy, the number one cause of blindness in working-age Americans.

Digital images of the retina are taken at the CAIH eye clinic, then transmitted over the Internet to Nashville, Tenn., where the three-dimensional images are evaluated by highly trained retinal readers.

A study published recently in the journal "Ophthalmology" states that this is the first digital system known to deliver "gold standard" evaluation of diabetic retinopathy.

"We implemented this system because we wanted to bring the diagnostic skills of the nation's leading eye-care experts to our patients," said Chickasaw Nation Governor Bill Anoatubby. "The implication of this study is that our efforts may well have a much wider impact."

Dr. John Garber operates the eye clinic at CAIH.

"The Chickasaws have participated in the development of new technology that will not only benefit the Indian people, but may benefit every diabetic in the world," Dr. Garber said. "That is what is so exciting about this.

"When patients in need of treatment are identified, retinal laser surgery is an extremely effective treatment and when appropriately timed, it can eliminate 90 percent of blindness and 60 percent of moderate vision loss caused by diabetic retinopathy. So that's the carrot on the stick, right there."

While effective laser treatment has been available for diabetic retinopathy for more than 20 years, the disease has remained the primary cause of blindness in adults 20 to 74 years of age. A major reason is that many people at risk for the disease do not receive the recommended annual dilated eye exam needed to diagnose the condition. In fact, while 90 percent of diabetics go to a primary care provider in any given year, only 40 percent get their eyes examined on an annual basis.

"It's really so frustrating to know how to manage a disease and the number one factor that is stopping us is not getting the patients in to be evaluated," Dr. Garber said. "That's why this system is so critical, because theoretically, any diabetic who steps through our front door has the opportunity that day to get their eyes evaluated by a system that has been validated to provide the gold standard evaluation of that retina.

"We don't really know all the reasons why people don't get in to see the eye doctor. We have to assume convenience is probably the number one reason, and now this is as convenient as picking up your medicines at the pharmacy."

That increased convenience has had an impact at CAIH, according to Dr. Garber. Since the system was implemented about two years ago, the rate of patients with diabetes receiving an annual eye exam has increased from a level similar to the national average of 40 percent to approximately 70 percent today. Dr. Garber expects that number to increase to somewhere around 90 percent once the Diabetes Care Center currently under construction centralizes all diabetes services in one location.

More than 500 people have utilized the diabetic retinopathy evaluation system at CAIH. Many of those were found to have the disease and subsequently received the prompt attention necessary to save their sight.

"You are finding telemedicine becoming more and more a component in Indian Health Service," Dr. Garber said. "The word is getting out that this is an excellent system.

"The beauty of the Internet is, it gives you the ability to access experts from across the nation. It might normally be a challenge to get all that brainpower into one locale. But now you can actually get all that brain power in one locale through the Internet."

Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year in the United States and is the number one cause of new blindness in adults 20 to74 years of age.

The disease occurs when the blood vessels that nourish the retina deteriorate. As they deteriorate, portions of the blood vessels may swell and leak fluid into the retinal tissue. This leakage may also cause swelling in the macula known as macular edema.

Approximately 6.2 percent of the United States population ? 17 million people ? have diabetes and 5.9 million of those cases are undiagnosed.

Among American Indians and Alaska Natives who receive care from the Indian Health Service, 15.1 percent have diabetes. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.