Telemedicine and Diabetic Retinopathy: Review of Published Screening Programs

Abstract

Background Diabetic Retinopathy (DR) is a leading cause of blindness worldwide even though successful treatments exist. Improving screening and treatment could avoid many cases of vision loss. However, due to an increasing prevalence of diabetes, traditional in-person screening for DR for every diabetic patient is not feasible. Telemedicine is one viable solution to provide high-quality and efficient screening to large number of diabetic patients. Purpose To provide a narrative review of large DR telemedicine screening programs. Methods Articles were identified through a comprehensive search of the English-language literature published between 2000 and 2014. Telemedicine screening programs were included for review if they had published data on at least 150 patients and had available validation studies supporting their model. Screening programs were then categorized according to their American Telemedicine Association Validation Level. Results Seven programs from the US and abroad were identified and included in the review. Three programs were Category 1 programs (Ophdiat, EyePacs, and Digiscope), two were Category 2 programs (Eye Check, NHS Diabetic Eye Screening Program), and two were Category 3 programs (Joslin Vision Network, Alberta Screening Program). No program was identified that claimed category 4 status. Programs ranged from community or city level programs to large nationwide programs including millions of individuals. The programs demonstrated a high level of clinical accuracy in screening for DR. There was no consensus amongst the programs regarding the need for dilation, need for stereoscopic images, or the level of training for approved image graders. Conclusion Telemedicine programs have been clinically validated and successfully implemented across the globe. They can provide a high-level of clinical accuracy for screening for DR while improving patient access in a cost-effective and scalable manner.

Fundamental principles of an effective diabetic retinopathy screening program

“…In a review, Das et al [41] determined that DR is highly suitable for telemedicine because it saves time and minimizes lost income for the patient. DR telescreening can also provide cost savings for health systems depending on the population being screened (see the "Cost-effectiveness of screening" section); for example, a review highlighted that remote and underserved areas benefited most, with one rural teleophthalmology program resulting in savings of $150 per patient over 7 years [42].…”

Validation of an Automated Screening System for Diabetic Retinopathy Operating under Real Clinical Conditions

“…According to the American Telemedicine Association Validation Level, the first phase of our APDR screening system can be classified as a category 1 program, with an on-disease/non-disease diagnostic criterion issued by the PCP [ 24 ]. Meanwhile, the second phase, characterized by the review of pathological retinographies by the referring ophthalmologist is classified as a category C2 program.…”

Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic

“…Screening with teleophthalmological means can have a significant impact on reducing vision loss caused by DR. Nationwide-based systems but also community-based programs are proving to boost the screening rates and result in avoiding visual complications around the world [33]. Tozel et al completed a review of large DR telemedicine screening programs for DR across the globe and demonstrated that a high level of clinical accuracy and easier patient access are accomplished [34]. Unnecessary referral minimizing and cost-saving are also reported in recent studies for both rural population and urban community teleophthalmology services [35,36].…”