Non-mydriatic fundus camera screening with diagnosis by telemedicine for diabetic retinopathy patients with type 1 and type 2 diabetes: a hospital-based cross-sectional study

Abstract

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden.OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes.DESIGN: Cross-sectional hospital-based study.SETTING: Diabetes center, Riyadh.PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR.MAIN OUTCOME MEASURES: Detection and classification of DR.SAMPLE SIZE: 978 Saudi patients with diabetes.RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension.CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes.LIMITATIONS: Conducted in a single center.CONFLICT OF INTEREST: None.

The Role of Telemedicine, In-Home Testing and Artificial Intelligence to Alleviate an Increasingly Burdened Healthcare System: Diabetic Retinopathy

“…Some authors recommend the use of OCT devices for more accurate and reliable detection of macular edema [ 23 , 44 , 58 , 72 – 76 ].…”

Mapping research trends in diabetic retinopathy from 2010 to 2019

“…[ 38 ] A hospital-based cross-sectional study showed that non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes. [ 39 ] Telemedicine services facilitate the evaluation, diagnosis, and management of remote patients. In ophthalmology, telemedicine is in its infancy, particularly in its application to DR, as current models are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist.…”

Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative

“…Also, as a technological issue, telemedicine retinal assessment programs have shown to be useful and practical, not only for screening but also for following-up diabetic patients [28-30]. Telemedicine could then lower health care costs by reducing the need for regular ophthalmology clinic visits, especially when large numbers of patients are followed at a hospital-based level [28-30]. Furthermore, even when eye care providers are available, telemedicine will increase the percentage of diabetic retinopathy screening exams [29].…”

“…However, although telemedicine is a valuable tool, it is not free of limitations. Poor quality images, patients who have transient housing, privacy, safety, and technology limitations have been identified as barriers to telemedicine implementation [28-30, 33]. Nonetheless, many ophthalmologists do not feel confident making decisions only based on images [33].…”