Foreseeing risk of blindness

Yousef KhalifaOphthalmologist Yousuf Khalifa initiated a screening program that has been implemented in four of Grady's primary care clinics, with other clinics scheduled for implementation in the coming months.


Grady Memorial Hospital

Porter Reynolds never much liked doctor visits, but he did go to one of Grady Hospital's primary care clinics whenever his insulin ran out.

 

Emory faculty and residents provide 80% of the care at the publicly funded Grady Hospital, leading programs targeted especially to problems experienced disproportionately by indigent, underserved populations.

In 2016-2017, Emory faculty provided $24.6 million in uncompensated care at Grady. All payments for Emory services for patients who have coverage go to the Emory Medical Care Foundation, which uses this revenue—$49.6 million last year—to support Emory's mission at Grady. 

That proved lucky this year, thanks to a new camera and medical record protocol implemented at the instigation of Emory ophthalmologist Yousuf Khalifa, chief of ophthalmology at Grady.

Reynolds had diabetes, and his medical record showed that he had not had an eye exam in more than a year, information that triggered the protocol. A specially trained technologist asked Reynolds if he could take a photo of the inside of his eyes using a special nonmydriatic camera. There was no need to dilate the pupil, he said, and no waiting or discomfort. "I can't pay for that," Reynolds said gruffly. "No problem," said the technologist.

Minutes later, the images were sent for interpretation. When the report came back, Reynolds got a call. He needed to go to Grady's eye clinic as soon as possible. The 47-year-old had end-stage diabetic retinopathy. Small blood vessels creeping across the eye were threatening to detach the retina, tissue that converts light into neural signals that the brain recognizes as images. In his case, the condition could still be treated. Untreated, it would cause permanent blindness.

Since Grady agreed to invest in the special cameras and hired technologists trained to operate them, Khalifa's screening program has been implemented in four of Grady's primary care clinics and the diabetes center where Emory physicians work, with other clinics scheduled for implementation in the coming months. Of more than 6,000 patients screened in the past nine months, roughly 3.5% had end-stage diabetic retinopathy, more than twice the national average.

These high-risk patients were moved to the top of the long waiting list at the Grady eye clinic. Reynolds was among the 67% who kept his appointment for vision-saving treatment, a percentage Khalifa is trying to raise to 100, despite the difficulties in reaching many patients with shifting addresses, lack of phones, and other issues related to homelessness.