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Alessandro Invernizzi, Maurizio Bevilacqua, Mariano Cozzi, Carlo Bianchi, Alessandro Pagani, Mario Cigada, Giovanni Staurenghi; Telemedicine for diabetic retinopathy screening: a pilot program for Italian hospitals. Invest. Ophthalmol. Vis. Sci. 2013;54(15):206.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the clinical reliability and economic impact of a semi-automatic fundus photography screening program for diabetic retinopathy in Italian population
A semi automatic fundus camera (DRS, Centervue Padua, Italy) was installed into the endocrinology unit at the Sacco Hospital of Milan. For 3 months, all the patients referring to the diabetic service, in addition to the standard systemic clinical evaluation, underwent a semi-automatic three fields fundus photographies set (FP) before and after pupil dilation. The pictures were than read by an expert ophthalmologist to assess the presence of diabetic retinopathy (DR). Rules to refer patients to the Retina clinic for fundus oculi (FO) examinations were: sign of diabetic retinopathy of any level, unreadable pictures. To test the sensitivity and specificity of the DRS fundus camera, a subset of patients independently of FP findings, also underwent FO examination. The costs and benefits evaluation of this telemedicine approach compared to the present screening method based on FO examination only in the Retina clinic was than conducted. The economical analysis was done on 3 months duration trial and one year projection was generated by these data.
347 patients underwent the semi-automatic FP screening program. FP examination without dilation results: 8,94%=presence of DR; 19,92%=absence of DR; 71,74%=unreadable pictures (UP); 80,08%=patients referred to the retinal unit (DR+UP). FP examination after pupil dilation results: 19,51%=presence of DR; 65,85%=absence of DR; 14,63%=UP; 34,15%=patients referred to the retinal unit (DR+UP). SE and SP of the non midriatic FP, assessed on a sample of 246 subjects, resulted respectively 96% and 24%; after pupil dilation they both resulted 78%. All the false negative patients generated by FP showed mild diabetic retinopathy at clinical FO examination. According to the annual projection, FP approach could increase the total number of screened patients for DR by 33%. Supposing the number of screened patients being equal, screening costs would be 20% less using miosis FP and 66% using midriatic FP when compared to the present approach.
Semi-automatic FP could be considered as a screening tool for DR in Italian population. Telemedicine could reduce costs of screening programs but the method should be improved to achieve a better cost-benefits balance.
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