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Miguel A Zapata, Gabriel Arcos, Alex Fonollosa, Maximino Abraldes; Telemedicine for a broad population screening of retinal diseases using non mydriatic fundus camera from optical centers: two years results. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1420.
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© ARVO (1962-2015); The Authors (2016-present)
Describe the outcomes during the first two years of a very specialize screening through a web platform using only a network of retinologists for the images lectures.
We recommended the screening in all patients arriving to the optician center. Opticians were responsible to collect the informed consent and perform a fundus photograph using non-mydriatic cameras. The ophthalmological report includes only diagnostic impressions and recommendation of referral time to conventional ophthalmological visit. Not definitive diagnosis was made; neither treatment nor further tests were recommended. All acute symptomatic patients, all findings exiting from strict normality and all patients with retinal signs of high myopia were referred to the ophthalmologist.
A total of 53.198 eyes from 26.627 patients were included, ranged from 3 to 99 years old, with a mean age of 52,89 years. Mean visual acuity was 0,91. There were a total of 1861 of known diabetics (7%). From all patients 74,9% (19.952) were normal, 24,5% (6523) were considered pathological and 0,57% (152) of cases were not assessable. From a total of 6523 patients who were referred, were urgently 7,28%, 11,74% did preferentially (within 2-3 weeks) and -80,98% did in the ordinary way. Signs of age-related maculopathy represented the most frequent pathology 1562 patients (5,9%). Epiretinal membrane was the second most frequently detected abnormality, with a total of 584 cases (2,2%). Choroidal nevi was the third cause of abnormality with 460 patients. Suspicion of diabetic retinopathy accounted for 347 patients, 5,3% of total pathological cases.<br /> An important increase of pathology was seen in patients over 50 years, 29.30 % of abnormalities in retinal photographs versus 11.2 % of abnormalities in the group under 50 years (p<0,0001; OR 3.41 IC 3.10-3.77). Patients with a myopic defect more than -3 spherical equivalent had higher risk of present abnormalities in the retinal images than the other patients (p=0.003; OR 1.15 IC 1.05-1.26).
Broad population screening is justified because of the high rate of asymptomatic retinal abnormalities. There is a high volume of patients going into the opticians and they should be controlled by an ophthalmologist. The ophthalmic community should lead these initiatives in order to preserve and guarantee the quality standards.
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