Examining the Role of Telemedicine in Diabetic Retinopathy (original) (raw)
Related papers
2020
Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) tri...
JAMA ophthalmology, 2015
Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. From August 1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a valid...
Telemedicine and e-Health, 2013
Objective: To determine the effectiveness of telemedicine for providing diabetic retinopathy screening examinations compared with the effectiveness of traditional surveillance in community health clinics with a high proportion of minorities, including American Indian/Alaska Natives. Subjects and Methods: We conducted a multicenter, randomized controlled trial and assigned diabetic participants to one of two groups: (1) telemedicine with a nonmydriatic camera or (2) traditional surveillance with an eye care provider. For those receiving telemedicine, the criteria for requiring follow-up with an eye care provider were (1) moderate nonproliferative diabetic retinopathy or higher, (2) presence of clinically significant macular edema, or (3) ''unable to grade'' result for diabetic retinopathy or macular edema. Results: The telemedicine group (n = 296) was more likely to receive a diabetic retinopathy screening examination within the first year of enrollment compared with the traditional surveillance group (n = 271) (94% versus 56%, p < 0.001). The overall prevalence of diabetic retinopathy at baseline was 21.4%, and macular edema was present in 1.4% of participants. In the telemedicine group, 20.5% would require further evaluation with an eye care provider, and 86% of these referrals were because of poorquality digital images. Conclusions: Telemedicine using non-mydriatic cameras increased the proportion of participants who obtained diabetic retinopathy screening examinations, and most did not require follow-up with an eye care provider. Telemedicine may be a more effective way to screen patients for diabetic retinopathy and to triage further evaluation with an eye care provider. Methods to decrease poor quality imaging would improve the effectiveness of telemedicine for diabetic retinopathy screening examinations.
Telemedicine and Diabetic Retinopathy: Review of Published Screening Programs
Journal of Endocrinology and Diabetes, 2015
Fortunately, when identified early and treated, the risk of vision loss is cut in half [2]. However, according to the National Committee for Quality Assurance, our current health care system meets guidelines for diabetic screening only by 40-60% of the time [3,4]. With a growing population of diabetics [5] and with work shortages projected for ophthalmologists [6], innovative approaches to diabetic retinopathy assessments could prevent needless vision loss. One approach is to use tele-ophthalmology to aid in the evaluation process by: 1) increasing local access to screening for diabetic retinopathy and 2) risk stratifying patients with diabetic eye disease so that those who require treatment can be scheduled more efficiently [7-9]. The American Telemedicine Association (ATA) has described four categories which classify telemedicine programs [10]. In this review, our aim was to provide a narrative review of the literature surrounding the four different categories of DR screening programs in the US and around the world. Methods Initial articles were identified by performing a PubMed search using the following key words: "diabetic retinopathy" or "diabetes and eye disease" and at least one of the following "telemedicine", "telepathology", "remote consultation", "mobile health units", "telemed", "teleimage", "teleEye", "telesurveillance", "teleophthalmology", "tele-consultation", or "tele-retina". Additional inclusion criteria were articles published in English, human studies, and publication after the year 2000. The final search was conducted on December 4, 2014. With this search, 168 articles were identified. For inclusion in this narrative review, a program had to have published data on at least 150 patients and describe the process of ATA validation for their telemedicine program. The purpose of this review was to focus on telemedicine programs that have been implemented. By limiting our review to programs that had evaluated at least 150 patients, we excluded programs that were in the pilot testing-phase. All abstracts were reviewed and 30 articles were identified that directly discussed validation or design of an included diabetic screening program. The bibliographies of articles that were read were then reviewed
Use of telemedicine in screening for diabetic retinopathy
Canadian Journal of Ophthalmology, 2003
Background: A diabetic retinopathy screening program was introduced in September 2000 at a university-affiliated hospital in Montreal to meet the demands of an overburdened health care system. In this article we describe our initial expe rience with this program.
Using Telemedicine to Increase Eye Care Screening Referral for People with Diabetes
Journal of Public Health Issues and Practices, 2019
Diabetes is the leading cause of preventable blindness among adults aged 20-74 years. Millions of Americans are affected by the complications and premature morbidity and mortality rates associated with diabetes mellitus (DM). We deal with two of these complications, visual impairment and blindness from diabetic retinopathy, that imposes a significant, increasing burden on patients, providers, and the health care system. These burdens are predicted to approximately triple over the next few decades.A major issue is that many people with diabetic retinopathy do not seek eye care, even if they are covered by insurance, because the disease is often symptom free until vision is significantly compromised. At this late stage, visual impairment is more difficult and more expensive to manage and often the damage is irreversible. A possible solution to increasing screening for diabetic retinopathy is Digital Teleretinal Imaging. We review the literature on this technology and offer a screening...
Diabetes-metabolism Research and Reviews, 2018
Aims. Diabetic retinopathy (DR) represents the main cause of blindness among adults in the industrialized Countries. Use of telemedicine could offer an easy, smart specialist fundus oculi examination, as well as putting in a screening program many patients who otherwise would be excluded. Materials and Methods. The NO Blind is a transversal, multicentre, observational study. Its pilot phase involved nine public outpatient clinics for six months. As endpoint of the study, we assessed the prevalence of DR by retinography in a subset of the Italian population. Patients' fundus oculi photos were performed by trained diabetologists through a digital smart ophthalmoscope. Results. According to our endpoint, in the final study population (n=1461), obtained excluding patients for whom retinography was not able to provide any diagnosis, DR This article is protected by copyright. All rights reserved. prevalence was equal to 15.5%. According to the ROC Curve performed, we can observe how retinography appears a highly accurate method to detect DR (AUROC 0.971 95% C.I. 0.954-0.989), with a specificity of the 100% and a sensitivity of the 94.3%. Conclusions. Our findings, in an Italian setting, confirm main data in the literature about DR prevalence. Hence, telemedicine could represent an accurate, fast and cheap method for screening of DR.
Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study in Hungary
Journal of diabetes research, 2016
Introduction. Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients' satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants' experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrád County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (Spectra™ software). Large majority of the patients were satisfied with the screening and found it ...
Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine
The Journal of Rural Health, 2001
Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. H m , rural individuals with diabetes may ham limited access to needed eye care. The objectiue of this project wyzs to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study inwlwcl a series of patients screened in primary care and public health locations throughout s m predominantly rural counties in eastern North Carolina. lmages of eachfundus w e obtained and sent to a retinal specialist. The retinal specialist revimd each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 wlunteers with a history of diabetes mellitus, 96.3 percent reported that they w e very comfortable or comfortable with the camera. Eighty-fiw percent of images w e rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman$ rank order correlation coeficient=0.79; P<O.OOZ). The auerage time since the previous examination by an eye care specialist for diabetic subjects zuz tux, years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which uxls diabetic retinopathy (40.9 percent). In this c o n m i m e sample, African Americans, despite similar age and disease duration, w e more likely to haw retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may i m p r m compliance with care guidelines for individuals with diabetes mellitus. iabetic eye disease is a leading cause of blindness in the United States (Ferris, et al., 1999), and with an increasing prevalence of diabetes mellitus, the incidence D may be increasing. Individuals who develop proliferative diabetic retinopathy have a 50 percent chance of blindness within five years. Appropriate detection and treatment can reduce that risk to less than 5 percent (Ferris, et al., 1999). There is usually a substantial lag between onset of diabetic eye disease and the development of blindness (Ferris, et al., 1999), suggesting a substantial role for screening. Practice guidelines for the care of patients with diabetes mellitus both in the United States (Aiello, et al., The authors acknowledge the assistance and support of Jay Roberstm in opliihalmic mluatwns, the assistance of a number of community members in providing s p e and coordinating scheduling, the assistance of Linda Wagener in formatting this manuscript and the support of Trade Oil Compny, Grmniille, NC, in prwiding a community service grant titled "Support for Eye Scrmiing Program.