Geographic Information Systems Mapping of Diabetic Retinopathy in an Ocular Telemedicine Network

Jani, Pooja D.; Forbes, Lauren; McDaniel, Philip; Viera, Anthony J.; Garg, Seema

doi:10.1001/jamaophthalmol.2017.1153

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…We were unable to assess clinician referral rates in this study, but previous studies indicate that eye care referrals among patients with diabetes are suboptimal (4). Telemedicine using nonmydriatic fundus cameras has emerged as a viable and effective DR screening option (15)(16)(17). These photos can be taken by health care personnel in primary care settings and then transmitted to reading centers for evaluation.…”

Section: Discussionmentioning

confidence: 99%

Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

et al. 2019

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OBJECTIVEDiabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10-64 years of age with diabetes. RESEARCH DESIGN AND METHODSWe used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam. RESULTSAmong the 298,383 insured patients with type 2 diabetes and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR were 24.4% and 15.8%, respectively, for patients with type 2 diabetes and 54.0% and 33.4% for patients with type 1 diabetes. CONCLUSIONSThe frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent visionthreatening eye disease among people with diabetes.

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Section: Discussionmentioning

confidence: 99%

Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

et al. 2019

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“…The North Carolina Diabetic Retinopathy Telemedicine Network (NCDRTN) is an innovative screening program developed to address the growing burden of DR in rural and underserved areas in the state. From 2014 to 2015, a total of 1,787 patients with diabetes in 5 Area Health Education Center primary care clinics received retinal screening photographs with remote expert interpretation to determine the presence and severity of DR [34].…”

Section: Trend Of Prevalence Of Self-reported Diabetic Retinopathy Inmentioning

confidence: 99%

Trends and Racial/Ethnic Disparities in Diabetic Retinopathy Among Adults with Diagnosed Diabetes in North Carolina, 2000–2015

Luo¹,

Bell²,

Garg³

et al. 2019

North Carolina Medical Journal

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D iabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and is the leading cause of blindness in the United States [1]. The prevalence of DM has increased rapidly in the United States. In 2015, an estimated 30.3 million people or 9.4% of the US population had DM [2]. By the year 2050, it is expected that about 48.3 million adults will be affected by DM [3]. The burden of DR may increase as more people have DM. It is estimated that about 16.0 million adults aged ≥ 40 years are projected to have DR by 2050 [4]. DR prevalence and complications are higher among racial/ethnic minority populations, including African Americans, Hispanics, and American Indians [5]. North Carolina is one of the 15 southern states identified as being in the "diabetes belt" by the Centers for Disease Control and Prevention [6]. North Carolina has the 13th highest prevalence of DM in the United States. An estimated 750,000 (1 in 10) adults in North Carolina have been diagnosed with DM [7]. By 2025, the number of people with DM in North Carolina is projected to increase to almost 1.9 million, with an annual cost to the state of $17.9 billion (including both medical and non-medical costs) [8]. Racial and ethnic disparities in DM prevalence are also significant in North Carolina. In 2013, 11.0% of non-Hispanic white adults had DM compared to 15.4% of non-Hispanic black adults [9]. The early stages of DR are often asymptomatic. Thus, early detection and treatment is imperative to preventing vision loss. Population-based studies on DR trends in the United States [10-12] are very limited. Little data exists on DR status in North Carolina [13]. The target of Healthy People 2020 is to reduce DR to 30.8 per 1,000 in the population aged 18 years and older with DM [14]. The purpose of this study is to describe the trends of DR in adults with DM and to assess racial/ethnic disparities in DR in the past 15 years in North Carolina. An update on the current status of DR will provide useful information for both eye care professionals and other medical providers in their practice and inform public health officials in the design or modification of interventions and policies regarding DR and DM. Methods Data For this study, data from the Behavioral Risk Factor Surveillance System (BRFSS) was analyzed. The BRFSS is an annual state-based, random-digit-dialed telephone survey of the non-institutionalized, US civilian population aged 18 years and older. The BRFSS questionnaire consists of 3 sections: a core survey, optional modules, and stateadded questions [15]. BRFSS has been proven to provide valid national and state estimates of health and risk factors [16]. In the BRFSS Core Questionnaire, respondents

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“…Therefore, screening for DR should be done promptly after diagnosis and at regular risk-based intervals thereafter. Numerous factors are known to affect attendance at DR screening [87][88][89][90][91]. In an established mobile retinal screening service in Scotland, poor attendance at screening was not linked to gender or to distance from the event, but was associated with younger age, longer duration of diabetes, smoking, social deprivation, and poor HbA1c and blood pressure control; the highest proportion of non-attenders were in urban areas [92].…”

Section: Barriers To Screeningmentioning

confidence: 99%

“…Geographic information system (GIS) mapping is useful for visualizing geographic access and barriers to eye care and may help identify underserved areas that would benefit from expansion of teleophthalmology screening programs [88]. In North Carolina, the authors used data on 1787 patients with diabetes who underwent retinal screening to develop qualitative GIS maps of patient and provider density around five telemedicine sites [88]. Results indicated that patient accessibility to healthcare professionals can be limited by geography and road networks.…”

Section: Barriers To Screeningmentioning

confidence: 99%

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Fundamental principles of an effective diabetic retinopathy screening program

et al. 2020

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Background Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. Methods A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. Results The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Twofield retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. Conclusion Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.

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Geographic Information Systems Mapping of Diabetic Retinopathy in an Ocular Telemedicine Network

Cited by 13 publications

References 24 publications

Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

Trends and Racial/Ethnic Disparities in Diabetic Retinopathy Among Adults with Diagnosed Diabetes in North Carolina, 2000–2015

Fundamental principles of an effective diabetic retinopathy screening program

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