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New retinal imaging will help detect eye defects as will as other diseases - Medical Speaking, Volume One, Number Four, 10/10/13

New retinal imaging will help detect eye defects as well as other diseases

If Rush Limbaugh says his radio program is 'on the cutting edge of societal evolution' then the Pharmacy Department at UNHS and Blue Mountain Hospital might be 'on the cutting edge of medical research evolution.'

The Pharmacy Department has been recognized for it's cutting edge Clinical Pharmacy Program, ScriptPro and Pyxis© ES Platform System of software and hardware for dispensing medications, and the sterile compounding of IV Medications with it's unique Isolator Hood. Now the Clinical Pharmacy Program is on the verge of using retinal eye scans to determine the need for eye surgery and treatment. And, in addition to using retinal eye scans to determine problems with the eyes, UNHS and Blue Mountain Hospital are helping spearhead a new pilot program with the Moran Eye Center at the University of Utah, and the Harvard University Medical School, for early detection of eye disorders due to diabetes, high blood pressure and high cholesterol with retinal eye scans.

The pilot program's intent is to demonstrate the benefits of using a retinal camera for early detection of diabetes, high blood pressure or high cholesterol by examining the blood vessels in the retina. The retina has tiny micro blood vessels that are extremely sensitive to changes in blood sugar, blood pressure and cholesterol levels. A retinal camera takes a high quality digital photo of the back of the eye. These pictures allow an eye surgeon to screen for problems with the eye, and other potential medical problems, based on the size of these micro vessels and other abnormalities. The retinal scan is one of the first places to detect early signs of diabetes, high blood pressure and high cholesterol, said Albert Noyes, PharmD with UNHS and Blue Mountain Hospital. Noyes went on to explain that a yearly retinal scan, or high quality fundus exam, is part of the standard care for diabetes, along with a full eye exam by an eye specialist.

"No one at UNHS or Blue Mountain Hospital is fully trained to evaluate these retinal images for the earliest signs of disease," Noyes noted. "But through a cooperative arrangement with the Moran Eye Center, the images can be read by a team of Ophthalmologists at the University of Utah, and at Harvard Medical School. Navajo-speaking patients, deep in the reservation, can actually have their retinal images read by Ophthalmologists at the University of Utah and Harvard Medical Schools," said Noyes. "It blows me away."

Noyes is helping lead the effort to get funding for the retinal-imaging collaboration approved. The first new retinal camera is in place at the UNHS Community Health Center in Montezuma Creek. It was donated to UNHS by the Moran Eye Center last spring. These cameras are state-of-the-art and they're expensive, approximately $30,000 each. UNHS has purchased two more Retinal Cameras that will soon be used to examine patients and determine if they need eye surgery. If retinal images from these cameras indicate surgery is needed, the Moran Eye Center will do surgeries at Blue Mountain Hospital, in Blanding, when possible. For more complicated cases they will do surgery at the University of Utah, in Salt Lake City. This will be a great benefit to patients on the Utah portion of the Navajo Reservation, and all residents of southeast Utah, who need eye treatment or surgery.

The retinal images will also be used to help detect the early stages of diabetes, high blood pressure and high cholesterol. Donna Singer, UNHS CEO said these retinal images will be a great tool for evaluating and diagnosing the early stages of these three diseases, and taking steps to prevent them from becoming more serious in the future. She said all residents of southeast Utah are eligible for these studies for early detection of diabetes, high blood pressure and high cholesterol.

Noyes explained that retinal images can detect problems, other than eye problems, that can't be detected anywhere else, and they can do it earlier. He is certain that with this retinal camera technology it is possible to screen a population and, with medical and lifestyle therapy, intervene to prevent the onset of diabetes, high blood pressure and high cholesterol. This is a tool not available until now, he said.

"A key aspect of the collaborative pilot project with the University of Utah is the opportunity to exchange data and receive a grant for research funding through the University of Utah Medical School and Pharmacy School," Noyes said. "The College of Pharmacy at the University of Utah is the second highest funded college of pharmacy for research in America."

But, he said, the tricky part is politics and the controversy with the word research. A research project in the 1970's, involving the Navajo population, didn't go well because the agency doing the studies shared its research with another agency without permission. This created political complications over the word 'research' that still persist, Noyes said.

The University of Utah will not start this pilot project until it has been fully approved by an Institutional Review Board. The U of U has it's own review board, and the Navajo Nation will also have a review board. These boards are panels of individuals with various backgrounds, including those with professional backgrounds. Their purpose is to ensure that research projects seeking funds operate in an ethical and patient-centered manner. Noyes is one of the principal investigators on this project for UNHS, along with the Moran Eye Center. He said there is no monetary gain involved in the project for anyone, and research will only be conducted within IRB approved bounds and monitoring.

"The only intent of this project is to demonstrate the benefits of retinal camera imaging in the early detection, and treatment of eye disease related to diabetes, high blood pressure and high cholesterol. It also affords the opportunity to publish the findings of the project in professional publications, and share them with the world," Noyes said.

Noyes hopes the U of U's review board will approve the project this month. Whether or not the Navajo Nation's review board will approve the project is unknown. Singer said she fully expects the project to be approved by the Navajo Nation, especially since UNHS is a main participant. However, Singer said the results of retinal imaging performed on Navajo patients cannot be used in any research study without the Navajo Nation's IRB approval. She stressed that Navajo patients will be tested with the new retinal cameras as soon as possible, and the retinal images will be used to help detect early signs of diabetes, high blood pressure and high cholesterol. However, the results of these tests will not be used in any research study without Navajo Nation IRB approval, and even then, not without a written release from each patient, allowing their results to be used in the study.

UNHS now has an older type of retinal camera that is not as efficient as the new ones. These old cameras require 16 or 17 pictures of each patient's eye, instead of the one picture needed with the new cameras. Also, with the old cameras, pictures were sent to an IHS Ophthalmology group in Phoenix, Arizona for clinical interpretation. Noyes said the results from this process were less than acceptable.

"The new cameras are less difficult to use than the old ones, very dependable, much more user friendly and they only require one image per eye. And, these new cameras are the ones recommended by the eye surgeons, who will read the images," Noyes added.

Noyes said currently, in most cases, patients are not treated for diabetes, high blood pressure or high cholesterol until the patient shows clinical signs of the disease, such as symptoms or lab results. With the retinal imaging, it is possible to detect Diabetic Retinopathy or Hypertensive Retinopathy (High Blood Pressure) much earlier, before they reach a more radical stage. Then these conditions can be treated with medication to help prevent them from becoming more severe. Another benefit of retinal imaging is the ability to detect Metabolic Syndrome, a common precursor to diabetes whose symptoms include obesity, elevated cholesterol and climbing blood pressure. Retinal imaging can be used as a tool for early detection of Metabolic Syndrome in younger adults and adolescents, allowing for early intervention to prevent more serious problems later in life.

"We are on the cutting edge of retinal imaging research, but it all hangs on Institutional Review Board approval and continued funding for the research study," Noyes said.

But, he added, he is optimistic the Institutional Review Boards will give their blessing to the project.

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