Comparing the Effectiveness of Telemedicine and Traditional Surveillance in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial

Abstract

The protocol of this study is registered as ''The Comparative Effectiveness of Telemedicine to Detect Diabetic Retinopathy'' with ClinicalTrials.gov having clinical trial registration number NCT01364129. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The sponsor or funding organization had no role in the design or conduct of this research. AbstractObjective: To determine the effectiveness of telemedicine for providing diabetic retinopathy screening examinations compared with the effectiveness of traditional surveillance in community health clinics with a high proportion of minorities, including American Indian/Alaska Natives. Subjects and Methods: We conducted a multicenter, randomized controlled trial and assigned diabetic participants to one of two groups: (1) telemedicine with a nonmydriatic camera or (2) traditional surveillance with an eye care provider. For those receiving telemedicine, the criteria for requiring follow-up with an eye care provider were (1) moderate nonproliferative diabetic retinopathy or higher, (2) presence of clinically significant macular edema, or (3) ''unable to grade'' result for diabetic retinopathy or macular edema. Results: The telemedicine group (n = 296) was more likely to receive a diabetic retinopathy screening examination within the first year of enrollment compared with the traditional surveillance group (n = 271) (94% versus 56%, p < 0.001). The overall prevalence of diabetic retinopathy at baseline was 21.4%, and macular edema was present in 1.4% of participants. In the telemedicine group, 20.5% would require further evaluation with an eye care provider, and 86% of these referrals were because of poorquality digital images. Conclusions: Telemedicine using nonmydriatic cameras increased the proportion of participants who obtained diabetic retinopathy screening examinations, and most did not require follow-up with an eye care provider. Telemedicine may be a more effective way to screen patients for diabetic retinopathy and to triage further evaluation with an eye care provider. Methods to decrease poor quality imaging would improve the effectiveness of telemedicine for diabetic retinopathy screening examinations.

Diabetes Eye Screening in Urban Settings Serving Minority Populations

“…28,29,34,36,45,46 Patients with proliferative disease were rare at all sites. From a public health perspective, our finding that most patients with DR had background DR, with almost 10% of persons with diabetes screened having maculopathy, indicates high potential for intervention in DR’s earliest phases when treatment can prevent vision loss.…”

Patient Attitudes Toward Telemedicine for Diabetic Retinopathy

“…[17][18][19][20][21] A randomized control trial showed that screening rates were 56% for traditional, inperson visits compared with 94% in the telemedicine group. 22 In England and Wales, DR is no longer the leading cause of blindness, which is attributed to a national DR telemedicine screening program. 23 Telemedicine for DR screening has the potential to grow rapidly as a result of these successes.…”

Survey on IoT solutions applied to Healthcare

“…The test performed was a diabetic retinopathy examination, a test that must be performed regular on diabetic patients to avoid eyesight lost, usually performed by a trained professional, but in this case performed by telemedicine with a non-mydriatic camera, [25].…”