How It Works
Diabetic retinopathy is one of the toughest complications of diabetes, especially because the disease doesn’t display early symptoms. But, with early detection and treatment, most cases of vision loss and blindness can be prevented.
The Joslin Vision Network (JVN) is an innovative retinal imaging device designed to detect these vision problems early on. Using Joslin’s custom software and specialized cameras, patients are evaluated for diabetic eye disease. This evaluation usually happens at their primary care physician’s, endocrinologist’s, or ophthalmologist’s office.
JVN images, along with other patient data, including blood pressure and A1C scores, are sent to the JVN Reading and Evaluation Center at Joslin Diabetes Center in Boston. At this point, Joslin’s expert team of ophthalmologists, optometrists, and clinical staff evaluate and interpret the images. They identify specific levels of diabetic retinopathy — and then offer appropriate treatment guidance for each patient.
While a patient is being seen in a primary care physician’s, endocrinologist’s, or ophthalmologist’s office, a JVN imaging specialist certified by Joslin Diabetes Center takes digital images of the patient’s retina using Joslin’s custom software and imaging hardware. The procedure is fast and pain free, and does not involve pupil dilation.
In addition to the patient’s digital retinal images, important medical and care history is gathered to identify risk factors that influence eye disease onset and progression and care management, including blood pressure and A1C scores (the average blood glucose measurement during the two to three months before the date the A1C test was taken). Key education material may be presented during the imaging process to help patients understand how general diabetes management affects vision.
The JVN images and medical and care information are sent to the JVN Reading and Evaluation Center at Joslin Diabetes Center in Boston where clinicians expert in diabetes eye care evaluate the cases. Evaluation and care summaries are returned to the ophthalmologist or primary care physician within two business days. The Joslin team also identifies ocular pathologies other than diabetic retinopathy if observed.
With regular and careful follow-up combined with timely and appropriate laser surgery and medical treatment, the JVN can reduce the risk for severe visual loss by over 95%.
JVN is based on more than a decade of research, development, and testing. The accuracy of JVN as a diagnostic tool for diabetic retinopathy has been rigorously described and validated in several scientific peer review journals.
These reports and other publications have provided full evidence of JVN’s clinical effectiveness and its ability to:
- Compare favorably with “Gold Standard” 35 mm stereo slides with dilated pupils (Ophthalmology 2001)
- Compare favorably with clinical exam through dilated pupils by retinal specialist (Retina 2003)
- Provide annual follow-up retina exam with retinal specialist when previously documented no or mild diabetic retinopathy (American Journal of Ophthalmology 2005)
- Enhance an existing eye care professional referral program in increasing the rate of surveillance and treatment of diabetic retinopathy (Diabetes Care 2005)
- Identify nondiabetic eye disease as compared with clinical exam through dilated pupils by retinal specialist (Ophthalmology May 2006)
- Match favorably the sensitivity and specificity of dilated retinal exams for detecting diabetic retinopathy (Diabetes Care, October 2006)
The Comprehensive Diabetes Management Program (CDMP) is diabetes management software with a "whole person" focus that provides tools for continuous care and contact between patients and their providers. Two issues informed its development:
- Wagner’s chronic care model – components that involve community, self-management, decision support, and technology
- The knowledge that the traditional physician-centered, acute-care model was not designed for the huge numbers of (largely underserved) people with diabetes.
- CDMP provides a "technology assist" to the care team with clinical, lifestyle and psycho-social health information at their finger tips.
We used readily available technologies to develop a one-stop, site customizable application. Using CDMP, patients and care providers may foster active, creative, and positive, continuing relationships that keep patients healthier.
Why this application?
We know successful self-management is a team effort between patient and providers. We also know that most care providers are not diabetes specialists. CDMP provides the lynch pin between patient and care team. It is a single source for:
- Clinical decision support.
- Treatment guidelines with customizable alerts and reminders.
- Imbedded clinical and behavioral quick surveys.
- A patient snapshot – single screen reference tool.
- CarePlanning – a focus for patient-provider conversation.
- Imbedded patient education tools.
- A data warehouse for measurement of effectiveness.
- The CDMP development process found its roots years ago with the Joslin Vision NetworkTM , where we observed that:
- Looking at a patient’s eyes produces some information.
- Looking at the clinical record yields some more.
- Adding a psycho-social or behavioral health dimension makes for better health outcomes, openness and patient participation.
Who uses CDMP?
Primary CDMP users are care managers who facilitate interactions between patients and the diabetes care team or direct providers. They are most often:
- Nurse practitioners
- Exercise physiologists
- Behavioral clinicians
- Some MDs
CDMP may be used in a large urban clinic or a medium–to-large suburban physician practice where a nurse or nurse practitioner sees chronic care patients for the majority of their routine appointments.
We work to complement onsite workflow and train providers in most efficient uses of CDMP for them, specifically.
- Clinical Snapshot – for patient review and reference.
- Patient Portal – secure uploads of data and patient-provider messaging.
- Survey Tools – assessing self-management, nutrition, depression.
- CarePlanning – flexible team approach, clinical and self management issues.
- Risk Profile – at-a-glance indicator helps drive CarePlanning.
- Alerts and Reminders – customizable to a site, with treatment guidelines.
- Image Catalog – JVN eye images, uploaded patient pictures, EMR imports.
- Clinical Studies Management – oversight of study detail, subject pool, etc.