• Ophthalmologist Takes the Fight Against Blindness to Big City Streets

    Written By: Beatrice Shelton
    Jan. 14, 2019

    Think telemedicine is only for rural areas, where access to doctors is limited and resources scarce? Think again. Ophthalmologist Lama Al-Aswad, MD, MPH, is showing that telehealth programs can reduce blindness among the most vulnerable populations living in America's big cities.

    Dr. Al-Aswad heads up the teleophthalmology initiative at Columbia University Medical Center in New York. For the last two years, she and her colleagues have been driving a new kind of vision screening van through the streets of New York City, looking to catch people in the earliest stages of eye disease so they can better treat them.

    Residents can walk up to the van without an appointment and be screened, free of charge, for four major sight-threatening conditions: glaucoma, cataracts, macular degeneration, and diabetic retinopathy.

    The van is unique not only because it provides comprehensive screening for the four leading causes of blindness, but also because it provides an immediate diagnosis. Typically test results and images are stored and later reviewed by a physician. In Dr. Al-Aswad's van, the patient's data is shared immediately with a physician offsite, who then has a teleconference with the patient to explain the findings and—if necessary—how they should be treated.

    Lama A. Al-Aswad, MD, MPH, director of the teleophthalmology initiative at Columbia University demonstrates the mobile unit’s registration process to a prospective patient. Patients provide a comprehensive health history before entering the clinic.
    Lama A. Al-Aswad, MD, MPH, director of the teleophthalmology initiative at Columbia University demonstrates the mobile unit’s registration process to a prospective patient. Patients provide a comprehensive health history before entering the clinic.

    Of the first 400 patients screened, about half were found to have an eye condition that require an ophthalmologist's care. About 20 percent were at risk of developing glaucoma, and 27 percent had diabetes or prediabetes, which puts them at risk of diabetic eye disease.

    "In a developing country there is no excuse for blindness," Dr. Al-Aswad said. "Lack of education is one problem. But people just don't see the eye doctor, even in a major city like New York."

    Nearly half of these patients hadn't had an eye examination in two or more years. Some had never had an eye exam.

    Columbia University worked with state hospitals, local safety net hospitals, and social workers in New York to make sure care was available to those who sought follow-up care.

    As the healthcare system seeks to reduce disparities in care, mobile health clinics can help bridge some gaps in care, potentially decreasing the rate of blinding eye diseases in the United Sates.

    The study is ongoing. In 2018, 992 individuals were screened between mid-April and October. Results suggest that teleophthalmology screenings show promise as a method of screening for eye disease.