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Note on Health Policy

How the UK passed the US in diabetes eye care

An important shift in healthcare perspective is struggling to take place in the United States; the shift between the care and health of an individual and the care and health of a population. The US has often been the leader in clinical research and technical advances, and diabetic retinopathy is an excellent example of this. Clinical studies in the 1980s showed the amazing effectiveness of early laser treatment in treating diabetic retinopathy and preserving vision. Yearly eye screening by an experienced eye doctor, so that early changes can be detected and treated, is so effective that in the largest study on long-term complications (people followed for over 30 years of diabetes), only 2 people from over a thousand showed serious vision decrease in one of their eyes, . Yet many people do not receive these yearly eye exams. To close this gap, researchers in the US developed a transportable camera that could be used in rural clinics and primary care offices to take photos of the eyes of people with diabetes. Anyone could be trained to take and even do some reading of the photos. Despite numerous trials showing the efficacy and reliability of this approach to eye screening, its use has not yet become widespread in the US, partly because of problems with reimbursement and with coordination of care. In contrast, the UK adopted the use of these cameras for nationwide screening, integrated it into their national health system, and have successfully reduced vision loss in their population so that diabetes is no longer the leading cause of visual loss in working age adults. We had better research, they had better translation, and a health system that encompasses population health, not just individual health.

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