On-Site Glaucoma & Ocular Disease Management

Scope of Services

Institutional Eye Care LLC can provide the on-site medical department of any correctional facility the technical components, testing and, if needed, ophthalmology oversight required to medically manage and diagnose most glaucoma, certain diabetic retina disease, macular degeneration and some other eye diseases without the inmate ever having to leave the facility.

Inmates with glaucoma are usually sent off site for visual fields, nerve fiber layer analysis, optical nerve head imaging and, possibly, pachymetry and angle assessment. Inmates with diabetic retinopathy or macular degeneration also require routine retina photos and nerve fiber layer analysis to properly manage their ocular complications. Institutional Eye Care LLC’s On Site Ocular Health Services provides this technical testing on site so that inmates with some of these problems can be managed thru their own on site medical department in their home institution.

Other areas where these services could be integrated into correctional medical care include neurology conditions resulting in visual field loss such as stroke, aneurysm or tumor. Visual fields can be useful in assessing closed head trauma. Institutional Eye Care LLC’s services can provide this data to other consulting physicians, neurologists or health care decision makers – not just to ophthalmologists or optometrists.

Specifically, the same routine as currently exists for off-site ophthalmology management referrals is followed. The medical department generates and approves the initial referral, consult request or recall. The inmate has pertinent data collected during our on-site clinic. This technical information is then forwarded to the managing eye doctor thru our own secure HIPAA complaint data sharing program. The eye doctor can then assess the data and make an initial diagnose, initiate an ongoing medical management plan, follow-up appointment and/or referral.

Institutional Eye Care LLC’s trained technical team travels to each individual correctional facility to perform visual acuity testing, nerve fiber layer analysis, routine visual fields, inter ocular pressure measurements (tonometry), corneal thickness measurement (pachymetry) and/or digital retinal imaging (photography).

Developed specifically for Institutional Eye Care LLC we have our own fully secure and HIPAA compliant cloud based data sharing program. This technology provides access for the managing eye doctor(s) anytime / anywhere. Our technical data can be integrated into any facility’s existing EMR program. However, our entire program is completely independent and does NOT require access to the facility’s computer system or the internet while on site.

On Site Technical Serives:

Visual Fields are performed on site using the EasyField portable visual field unit by Oculus. This fully portable visual field unit provides 24-2 and many other visual software programs required to manage glaucoma and other visual field loss.

Nerve Fiber Layer Analysis is accomplished using the portable iVue OCT by Optovue. OCT’s reveal and quantify the integrity of the microcellular structures and thickness of the retinal nerve fiber layer. This is the “gold standard” in differentiating glaucoma patients with progressive optic nerve damage – often before change could be determined using more standard tests. It also quantifies retina and macular edema, hemorrhages and changes in retina thickness required to properly assess and manage diabetic retinopathy, macular degeneration and other eye health conditions.

Pachymetry, corneal thickness measurements is part of the iVue system. This program provides corneal thickness assessment for the entire cornea – not just a selected area or average of multiple tests.

Angle Imaging is also part of the iVue system. Utilizing this program the managing eye doctor is provided a permanent image of the drainage angle.

Retinal Photography, i.e. digital imaging, is performed using the EasyScan by I-Optics or iCam non-mydriatic camera system. This is standard of care in managing most retinopathies. Non-mydriatic cameras offer the potential to acquire retina images without dilating the pupil. Digital images afford a greater level of permanent documentation accuracy compared to hand written notes or drawings.

Tonometry is performed using the Avia Tonopen by Reichert. The Avia performs 10 separate inter-ocular pressure measurements with a standard deviation to assure accuracy.

What the Site Needs to Do:

Each facility is responsible to generate a clinic line of inmates requiring care. Scheduling should be arranged such that our technicians have an interrupted flow of inmates for testing.

Generally, two to three inmates per hour can be fully assessed. The maximum time for a clinic is four (4) hours per clinic including down time, count, etc. and begins when the technician arrives at the facility. To assure we have plenty of time to assess each inmate, we cap each clinic at 14 evaluations.

A reasonable work space providing privacy, electrical services and able to be darkened is required. The visual field unit, nerve fiber layer analyzer, retina camera and their supporting lap top computers require a table or desk top and electrical service.

Institutional Eye Care LLC is the only provider of these complete services including our web based secure data sharing capability in the country. We first implemented this service in 2000.

Jeffrey R. Lose OD developed, piloted and initiated on site glaucoma management services for Institutional Eye Care LLC beginning in 2000.  Dr. Lose remains Institutional Eye Care LLC’s director of our corrections Telemedicine/Data Collection Services.