Discovery Health simplifies access to screening for diabetic retinopathy and introduces cutting-edge Artificial Intelligence-driven technology to the process

• Discovery Health launches new Diabetic Retinopathy Screening Benefit, enhanced by a cutting-edge Artificial Intelligence system and designed to detect the onset of diabetic retinopathy as early as possible.

AI technology heralds a new era for eye screening, which is fundamental to nipping diabetic retinopathy in the bud

People who live with diabetes (whether type 1 or 2) are at heightened risk for several serious healthcare complications that affect various parts of the body. One of these complications is a condition known as diabetic retinopathy, and this can severely affect vision over time.

Persistently high blood sugar levels, which are typical of diabetes, cause damage to blood vessels throughout the body. This damage is more apparent in smaller blood vessels which are more vulnerable – like the tiny blood vessels at the back of the eyes. Diabetic retinopathy is a condition in which there is damage to the blood vessels of the light sensitive tissue at the back of the eye.

“This condition may present with only minor changes in our vision which may come and go, but it can also be entirely asymptomatic,” says CEO of Discovery Health, Dr Ryan Noach. “Of course, tight control of diabetes is key to preventing the start and progression of diabetic retinopathy. However, regularly undergoing screening for the early warning signs of diabetic retinopathy is equally important to nipping the condition in the bud, and ensuring good eye health.”

“This is why Discovery Health Medical Scheme (DHMS) has launched the new Diabetic Retinopathy Screening Benefit, designed to detect the onset of diabetic retinopathy as early as possible.”

“Through this benefit, we hope to increase the number of DHMS members who are screened for diabetic retinopathy. We take great pride in offering screening using the best available assessment tools and leading artificial intelligence technologies while we also have the great privilege of sending each member to our excellent network of participating optometrists, ophthalmologists, and GPs for their screening, broader assessment and clinical management.”

Less than one quarter of scheme members living with diabetes were screened in 2020

“Our analysis of screening rates among DHMS members who are living with diabetes unfortunately shows low levels of adherence to important annual screening checks. In 2020, only 24% of DHMS members living with diabetes were screened for diabetic retinopathy,” explains Dr Noach.

“It is understandable that one of the impacts of the COVID-19 pandemic and associated mitigation measures, has been a change to health seeking behavior, and a consequent marked reduction in care for non-COVID conditions. Preventative and screening healthcare interventions have declined markedly since the start of the pandemic. It is critical that we reverse these trends to detect the onset of diabetic retinopathy as early as possible - even before symptoms appear.”

“Discovery Health has always focused on incentivising, simplifying and enhancing member access to evidence-based preventative healthcare screening. The DHMS Diabetic Retinopathy Screening Benefit is fully aligned to this ethos. It gives members easy access to annual screening which is conducted using cutting-edge AI technology, followed up by a clear referral process, and supported by scheme benefits. We have also set up automated reminders that will prompt eligible scheme members to report for their annual screening check.”

“Regardless of which medical plan a member is on, they have access to screening that can prevent the significant reduction in their quality of life that advanced diabetic retinopathy brings.”

The Diabetic Retinopathy Screening Benefit follows a simple, three-level process:

1. Primary grading: Photography of the retina and assessment for signs of diabetic retinopathy

• Participating healthcare professionals use a digital retinal camera to take photographs of their patients’ eyes.
• These photographs are uploaded to a highly sensitive artificial intelligence (AI) system that automatically generates a report.
• Where no signs of disease are detected, members can be screened again in the next year.

2. Secondary grading: Eye examination performed by an optometrist

If signs of disease are detected by the AI system during primary grading, a full eye examination for secondary grading may occur at the same or subsequent appointment.

3. Tertiary grading: Diagnosis and treatment by an ophthalmologist

Following secondary grading, where necessary, scheme members will be referred to an ophthalmologist to confirm the diagnosis of retinopathy, and for long-term specialist care.

Benefits for scheme members and healthcare providers

“This simple yet highly comprehensive three-step process ensures that eligible scheme members benefit from the chance to utilise the highly-accessible services of optometrist practices for the necessary screening,” adds Dr Noach. “Furthermore, the primary and secondary grading levels require no member co-payments at all as these are funded from scheme benefits.”

“Diabetes care teams are enhanced by the inclusion of participating optometrists and GPs, who offer digital fundus camera photography analysed by an advanced AI system.”

Frank Cheng – President of Eyenuk, developer of the EyeArt^TM AI Eye Screening System, adds, “We applaud Discovery Health’s leadership for being the first payor to bring our EyeArt AI system to South Africa. The EyeArt AI system is the most extensively validated and adopted AI system for automated DR detection in real-world settings. It has been cleared by regulatory authorities around the world, including the U.S. Food and Drug Administration (FDA), and is reimbursed by government and private payors in the U.S.”

Details around accessing the Diabetic Retinopathy Screening Benefit

- Eligibility for the Diabetic Retinopathy Screening Benefit

The Diabetic Retinopathy Screening Benefit will be available to all patients who are registered on the Chronic Illness Benefit (CIB) for diabetes Type 1 or Type 2.

1. The benefit covers one annual retinal screening each year for diabetic retinopathy (DR).
2. Qualifying scheme members do not require pre-authorisations to access the necessary cover.

- Locating participating healthcare practitioners

Find a provider who is part of our screening network by logging on to www.discovery.co.za> Medical aid > Find a doctor > Find a doctor close to you. Search for "Optometrists" in an area conveniently located for you. You can find providers who offer screening for diabetic retinopathy by filtering your search:

1. Select "COVER"
2. Deselect "Full network Cover" and choose "Additional/Other Cover" to select "Diabetic Retinopathy Screening".

- 2021 DHMS cover for primary grading exams

DHMS pays for primary grading examinations from Scheme benefits.

If indicated following primary grading, secondary grading examinations are also paid from scheme benefits.

“This means that patients will not have out-of-pocket payments and that no claims will be deducted from their Medical Savings Account (MSA) balance,” says Dr Noach.

- Participating healthcare providers may not charge extra fees for primary and secondary grading examinations.