Telemedicine for Diabetic Retinopathy Screening in an Urban, Insured Population Using Fundus Cameras in a Primary Care Office Setting

Abstract

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the “capture rate.” RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274–e277.]

Diabetic eye disease: A review of screening and management recommendations

“…When studied in an urban setting with a large number of diabetic patients, telemedicine detected retinal pathology in over 30% of patients with 11% of all patients having sight‐threatening DR 36 . This study demonstrated a capture rate of over 80% 36 . Jani et al evaluated telemedicine for DR screening in a rural setting and found that 9% of all screened patients required an ophthalmology referral 10 .…”

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

“…It is supported by a trained nurse or technician using an educational pamphlet translated into local languages, highlighting the importance of regular eye screening. These images can be used in initial screening for the presence of disease, and can help determine whether patients require a dilated exam by an ophthalmologist [ 32 , 78 – 81 ]. Web-based portable fundus cameras were presented by Keshvardoost et al [ 82 ].…”

“…Several DR telescreening models have been implemented. Retinal images are generally acquired by trained primary care physicians, technicians, ophthalmic photographers and nurses [ 7 , 10 , 12 , 13 , 15 , 17 , 18 , 20 , 22 , 23 , 25 – 27 , 27 – 31 , 53 – 60 , 63 – 65 , 68 – 72 , 51 – 53 , 53 , 97 – 101 , 57 , 58 , 58 , 59 , 26 – 30 , 64 , 64 , 65 , 65 , 48 – 55 , 58 – 60 , 63 – 67 , 81 , 82 , 82 , 83 , 79 – 83 ].…”

“…The data collected in medical centers from diabetic patients during camera-based fundus examinations are sent for diabetic retinopathy detection to experts including ophthalmologists or retinal specialists [ 13 , 16 , 18 , 20 , 21 , 23 , 24 , 26 – 29 , 32 , 33 , 35 , 42 – 45 , 47 – 52 , 54 , 56 , 64 , 67 – 75 , 79 , 81 – 83 ], certified technicians and nurses; in more complicated cases, the data are reevaluated by retinal specialists [ 12 , 15 , 20 , 31 , 41 , 44 , 59 , 63 , 66 , 78 , 102 ].…”

Setting Up Tele Health Facilities at Peripheral Small-Scale Healthcare Set Ups

“…Though it"s difficult to cover all the variant modes of tele medicine, some prototype tele health projects are being shared. Using fundus camera diabetic retinopathy (DR) was screened in a large population group with author documenting a better capture rate for DR without loss of many patients to routine follow up 12 . Another study by Patterson demonstrated desirable epilepsy management outcomes in resource scarce countries by using tele medicine use under guidance by non-physician workers, which is normally considered a serious condition with emergent and timely medical interventional needs 13 .…”