Implementation of Teleretinal Screening Using Optical Coherence Tomography in the Veterans Health Administration

Ashrafzadeh, Sahar; Gundlach, Bradley S.; Tsui, Irena

doi:10.1089/tmj.2021.0118

Cited by 6 publications

(8 citation statements)

References 18 publications

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“…This starts with educating ourselves about health inequity and associated SDOH. At the local level, ophthalmologists can examine their own practices for opportunities to close the access gap, including providing income-adjusted payment for care of populations with low income or for telehealth visits (eg, teleretinal screening) for remote populations with limited health care access . Additional outreach interventions include education on ophthalmic health, for example, at schools; school-based, primary care– or pediatrician-conducted, and community-based screenings; and home or outreach visits for remote populations and those unable to travel to an ophthalmologist, such as nursing home residents or incarcerated individuals .…”

Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Besagar

Yonekawa

Sridhar³

et al. 2022

JAMA Ophthalmol

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ImportanceApproximately 13% of US adults are affected by visual disability, with disproportionately higher rates in groups impacted by certain social determinants of health (SDOH).ObjectiveTo evaluate SDOH associated with severe visual impairment (SVI) to ultimately guide targeted interventions to improve ophthalmic health.Design, Setting, and ParticipantsThis quality improvement study used cross-sectional data from a telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) that was conducted in the US from January 2019 to December 2020. Participants were noninstitutionalized adult civilians who were randomly selected and interviewed and self-identified as “blind or having serious difficulty seeing, even while wearing glasses.”ExposuresDemographic and health care access factors.Main Outcomes and MeasuresThe main outcome was risk of SVI associated with various factors as measured by odds ratios (ORs) and 95% CIs. Descriptive and logistic regression analyses were performed using the Web Enabled Analysis Tool in the BRFFS.ResultsDuring the study period, 820 226 people (53.07% female) participated in the BRFSS survey, of whom 42 412 (5.17%) self-identified as “blind or having serious difficulty seeing, even while wearing glasses.” Compared with White, non-Hispanic individuals, risk of SVI was increased among American Indian/Alaska Native (OR, 1.63; 95% CI, 1.38-1.91), Black/African American (OR, 1.50; 95% CI, 1.39-1.62), Hispanic (OR, 1.65; 95% CI, 1.53-1.79), and multiracial (OR, 1.33; 95% CI, 1.15-1.53) individuals. Lower annual household income and educational level (eg, not completing high school) were associated with greater risk of SVI. Individuals who were out of work for 1 year or longer (OR, 1.78; 95% CI, 1.54-2.07) or who reported being unable to work (OR, 2.90; 95% CI, 2.66-3.16) had higher odds of SVI compared with the other variables studied. Mental health diagnoses and 14 or more days per month with poor mental health were associated with increased risk of SVI (OR, 1.87; 95% CI, 1.73-2.02). Health care access factors associated with increased visual impairment risk included lack of health care coverage and inability to afford to see a physician.Conclusions and RelevanceIn this study, various SDOH were associated with SVI, including self-identification as being from a racial or ethnic minority group; low socioeconomic status and educational level; long-term unemployment and inability to work; divorced, separated, or widowed marital status; poor mental health; and lack of health care coverage. These disparities in care and barriers to health care access should guide targeted interventions.

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Section: Discussionmentioning

confidence: 99%

Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Besagar

Yonekawa

Sridhar³

et al. 2022

JAMA Ophthalmol

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“…17 In the paper by Maa et al, despite the detailed cross-sectional analysis of the macula, optic nerve head and retinal nerve fibre layer that is provided in OCT scans, the authors did not detect any improvement in sensitivity or specificity of fundus photography for the detection of glaucoma and retinal disorders with the addition of OCT. 17 In contrast to these results, other groups have clearly demonstrated a role for OCT in addition to fundus photographs, especially for the detection of diabetic macula oedema which requires a stereoscopic view. [31][32][33][34][35] In the current metaanalysis, only a fraction of the studies used OCT alone or as an adjunct modality in addition to fundus photographs and we were unable to perform a formal meta-regression. Due to widespread use of OCT as well as recent advances in OCT technology such as swept-source OCT and OCT angiography, it is inevitable that more data will become available in the near future.…”

Section: Discussionmentioning

confidence: 93%

Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis

et al. 2022

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ObjectiveTo evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD).Methods and analysisThis study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO).Results28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low).ConclusionTeleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation.PROSPERO registration numberCRD42020191994.

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“…Teleophthalmology initiatives showed that including OCT can improve the efficiency of DR/DME screening programs. Given the advantages of the OCT device for DME assessment, OCT will be likely incorporated in well-established DR screening programs with screen-positive maculopathy [14,15].…”

Section: Telemedicine In Dr Screeningmentioning

confidence: 99%

“…Non-mydriatic fundus camera hard-mounted in offices or mobile, on vehicles 45° and 60°U ltra-wide-field cameras [12,13] Hard-mounted in offices or mobile, on vehicles 200° (Optos PLC, Dunfermline, Scotland, UK) 133° or 200° with montage Clarus (Carl Zeiss Meditec, Inc, Dublin, CA) 105° (Heidelberg Engineering, Inc., Heidelberg, Germany) 150° with montage or 110° in a single shot with the UWF module or 200° with three mosaic images (Eidon, ICare, Finland) 163° (Mirante, NIDEK Co., Ltd., Aichi, Japan) Portable fundus cameras [18] Portable hand-held camera (possibility for in-home testing) 40° (Visuscout 100, Carl Zeiss, Jena, Switzerland) 40° (Optomed smartscope Pro, Optomed plc, Finland) 45° × 40° (VersaCam α, Nidek Co. Ltd., Japan) 50° × 40° (Signal, Topcon, Tokyo, Japan) 50° Volk Pictor Prestige (Volk Optical, Inc, Mentor, USA) 45° Dragonfly (Eyefficient; Aurora, Ohio, USA) Smartphone-based retinal imaging system [19,20,22,23] Adaptors for commercially available smartphones 25° (iExaminer adapter, WelchAllyn, Skaneateles Falls, New York)* 6-20° (D-Eye, Padova, Italy)* 20-30° (Peek Retina, Peek Vision, London) 50° (Volk iNview, Volk Optical, Inc, Mentor, USA)* 56° Paxos Scope (DigiSight Technologies; San Francisco, USA)* 45° Fundus on Phone device (Remidio Innovative Solutions, Bangalore, India)* 60° Vistaro (Remidio Innovative Solutions Pvt. Ltd., Bangalore, India) MII RetCam (Make In India Retinal Camera) OCT imaging [14,15] Complementary strategy in DR telescreening pathway to improve accuracy of DME detection…”

Section: Tabletop/traditional Fundus Camerasmentioning

confidence: 99%

Digital innovations for retinal care in diabetic retinopathy

et al. 2022

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Aim The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). Methods A PubMed engine search was performed, using the terms “Telemedicine”, “Digital health”, “Telehealth”, “Telescreening”, “Artificial intelligence”, “Deep learning”, “Smartphone”, “Triage”, “Screening”, “Home-based”, “Monitoring”, “Ophthalmology”, “Diabetes”, “Diabetic Retinopathy”, “Retinal imaging”. Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. Results Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. Conclusions Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.

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Implementation of Teleretinal Screening Using Optical Coherence Tomography in the Veterans Health Administration

Cited by 6 publications

References 18 publications

Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis

Digital innovations for retinal care in diabetic retinopathy

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