Early Experience with Technology-Based Eye Care Services (TECS)

Maa, April Y.; Wojciechowski, Barbara; Hunt, Kelly J.; Dismuke, Clara E.; Shyu, Jason; Janjua, Rabeea; Lu, Xiaoqin Alexa; Medert, Charles M.; Lynch, Mary G.

doi:10.1016/j.ophtha.2016.11.037

Cited by 51 publications

(39 citation statements)

References 27 publications

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“…SEC is a smartphone attachment that allows video recording [ 8 ], and thus, it may be useful in telemedicine. Several studies have demonstrated that ophthalmological diagnoses are amenable to remote medicine, as the diagnosis is made based on images of the eye [ 18 , 19 ]. To the best of our knowledge, there is no other portable and recording device that can take a distinct eye photo with a thin slit-light.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Nuclear Cataract with Smartphone-Attachable Slit-Lamp Device

et al. 2020

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Background: Visual impairments and age-related eye diseases need to be detected and treated in a timely manner. However, this is often hampered by lack of appropriate medical equipment. We have invented a portable, recordable, and smartphone-attachable slit-lamp device, called the Smart Eye Camera (SEC). The aim of this study was to compare evaluating nuclear cataract (NUC) between the SEC and the conventional, non-portable slit-lamp microscope. Methods: A total of 128 eyes of 64 Japanese patients (mean age: 73.95 ± 9.28 years; range: 51‒92 years; female: 34) were enrolled. The NUC was classified into four grades (grade 0 to 3) based on three standard photographs of nuclear opacities according to the WHO classification by ophthalmologists. An ophthalmic healthcare assistant (non-ophthalmologist) filmed the eyes in video mode by the SEC and an ophthalmologist graded the NUC. Grade correlation and inter-rater reproducibility were determined. Results: NUC grading by the two approaches correlated significantly (both eyes: r = 0.871 [95%CI: 0.821 to 0.907; p < 0.001]). Inter-rater agreement was high (weighted κ = 0.807 [95%CI: 0.798 to 0.816; p < 0.001]). Conclusions: This study suggests that the SEC is as reliable as the conventional non-portable slit-lamp microscope for evaluating NUC.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Nuclear Cataract with Smartphone-Attachable Slit-Lamp Device

et al. 2020

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“…Thus, early detection of glaucoma in veterans, even when no ophthalmology care is available in-house, will be important so patients can receive appropriate evaluation, follow-up, and potential surgical intervention by a community ophthalmologist. In addition, the integration of a teleophthalmology system that would extend care to a large number of rural veterans is currently being evaluated within the VA. 16 With teleophthalmology, patients with high-risk features could be reviewed by ophthalmologists at a distant, centralized location to determine whether a face-to-face ophthalmology evaluation with possible surgical intervention is warranted. Teleophthalmology has been used in other health care systems that render care to rural patients.…”

Section: Discussionmentioning

confidence: 99%

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

Lee

Pieters

et al. 2018

JAMA Ophthalmol

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IMPORTANCE Glaucoma is a common cause of visual impairment in the Veterans Affairs (VA) health care system, but to our knowledge, no data exist concerning tertiary glaucoma care (ie, laser and filtering surgery). OBJECTIVE To determine whether the rate of tertiary glaucoma care differs among veterans cared for through the 4 different eye care delivery models that are present in the VA: optometry-only clinics, ophthalmology-only clinics, clinics with optometry and ophthalmology functioning as a single integrated clinic with ophthalmology as the lead, and clinics with optometry and ophthalmology functioning as separate clinics. DESIGN, SETTING, AND PARTICIPANTS In this retrospective review of the Veterans Health Administration Support Service Center database, 490 926 veterans with a glaucoma-related diagnosis received care from 136 VA medical centers during fiscal year 2016. Demographic and baseline clinical factors, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology codes, and the rates of glaucoma surgery procedures were extracted from the database. The organizational structure of each VA eye clinic was obtained. Univariate and multivariate regression analyses were performed for log percent for laser peripheral iridotomy (LPI), laser trabeculoplasty (LTP), and filtering surgery. MAIN OUTCOMES AND MEASURES Rates of LPI, LTP, and filtering surgery. RESULTS Of the 490 926 veterans with a glaucoma-related diagnosis, 465 842 (94.9%) were male, 309 677 (63.1%) were white, and 203 243 (41.4%) were aged 65 to 74 years. The rate of LPI was 0.30%, 0.28%, 0.67%, and 0.69% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of LTP was 0.31%, 1.06%, 0.93%, and 0.92% in care delivery models that included optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of filtering surgery was 0.32%, 0.51%, 0.69%, and 0.60% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). Multivariate regression analyses showed that these differences remained significantly different even after adjusting for potential confounders. CONCLUSIONS AND RELEVANCE Disparities exist in the use of tertiary glaucoma services within the VA, and different care delivery models may play a role. Outcomes of glaucoma care for the different models of eye care delivery were not analyzed in this study.

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“…DR [ 8 ] and DME [ 9 ] are leading causes of severe and moderate vision loss among working age adults in the US despite the effectiveness of timely diagnosis and treatment. Because approximately half the AI/AN population with diabetes fails to obtain the recommended annual retinal examination required to allow appropriate DR management, the Indian Health Service (IHS) implemented a primary care-based teleophthalmology program in 2000 to increase compliance with DR surveillance standard of care [ 10 ], and improve efficiencies [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Bursell

Fonda²,

Lewis³

et al. 2018

PLoS ONE

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BackgroundDiabetes and its complications are more common in American Indians and Alaska Natives (AI/AN) than other US racial/ethnic populations. Prior reports of diabetic retinopathy (DR) prevalence in AI/AN are dated, and research on diabetic macular edema (DME) is limited. This study characterizes the recent prevalence of DR and DME in AI/AN using primary care-based teleophthalmology surveillance.MethodsThis is a multi-site, clinic-based, cross-sectional study of DR and DME. The sample is composed of AI /AN patients with diabetes (n = 53,998), served by the nationally distributed Indian Health Service-Joslin Vision Network Teleophthalmology Program (IHS-JVN) in primary care clinics of US Indian Health Service (IHS), Tribal, and Urban Indian health care facilities (I/T/U) from 1 November 2011 to 31 October 2016. Patients were recruited opportunistically for a retinal examination using the IHS-JVN during their regular diabetes care. The IHS-JVN used clinically validated, non-mydriatic, retinal imaging and retinopathy assessment protocols to identify the severity levels of non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), DME, and sight threatening retinopathy (STR; a composite measure). Key social-demographic (age, gender, IHS area), diabetes-related health (diabetes therapy, duration of diabetes, A1c), and imaging technology variables were examined. The analysis calculated frequencies and percentages of severity levels of disease.ResultsPrevalence of any NPDR, PDR, DME, and STR among AI/AN patients undergoing DR teleophthalmology surveillance by IHS-JVN was 17.7%, 2.3%, 2.3%, and 4.2%, respectively. Prevalence was lowest in Alaska and highest among patients with A1c >/ = 8%, duration of diabetes > 10 years, or using insulin.ConclusionsPrevalence of DR in this cohort was approximately half that in previous reports for AI/AN, and prevalence of DME was less than that reported in non-AI/AN populations. A similar reduction in diabetes related end-stage renal disease in the same population and time period has been reported by other researchers. Since these two diabetic complications share a common microvasculopathic mechanism, this coincident change in prevalence may also share a common basis, possibly related to improved diabetes management.

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Early Experience with Technology-Based Eye Care Services (TECS)

Cited by 51 publications

References 27 publications

Evaluation of Nuclear Cataract with Smartphone-Attachable Slit-Lamp Device

Evaluation of Nuclear Cataract with Smartphone-Attachable Slit-Lamp Device

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

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