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Nour Maya N Haddad, Ramon Cancino, Paolo S Silva, Eyiuche Okeke, Ann Tolson, Lloyd Paul Aiello, Jerry D. Cavallerano; Ultrawide Field Imaging (UWFI) for Diabetic Retinopathy in a Community-Based Teleophthalmology Program. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1425.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the outcomes of an ocular UWFI teleophthalmology program in an urban community health center and to determine the impact of peripheral retinal lesions on DR severity in such a setting
We reviewed the outcomes of a Joslin Vision Network (JVN) program from May 30, 2014 to November 10, 2014 deployed at the Mattapan Community Health Center in Boston, MA which serves a largely underserved population without ready access to ophthalmic care. All patients underwent UWFI using a Daytona Retinal Imager (Optos, plc, Dunfermine, Scotland, UK) following a previously validated image acquisition protocol of 2000 stereoscopic pairs of retinal images for each eye. All JVN images were evaluated following a standardized validated protocol on identical color calibrated LCD high resolution computer monitors by trained licensed graders
A total of 105 consecutive patients were imaged with UWFI. Mean age was 63.1 years (±14.7), mean diabetes duration 9.4 years (±8.4), 69.5% Female, and 90% black. DR severity by patient was no DR 61.9% (65), very mild nonproliferative DR (NPDR) 10.5% (11), mild NPDR 5.7% (6), moderate NPDR 6.7%(7), proliferative DR (PDR) 5.7%(6), and ungradable 9.5% (10). Diabetic macular edema (DME) was present in 7.6% (8) of the patients. Referable DR (moderate NPDR or worse, or any level of DME) was present in 16.2% of the patients. Peripheral DR lesions were present in 37.7% of eyes with DR, suggesting a more severe level of DR in 11.6%. Optic nerve evaluation was suspicious for glaucoma in 4.8% of the eyes imaged. The monthly rate of ungradable patient images decreased from 42.9% during the first two months to less than 5% subsequently given increased imager experience over the 6 month study period
The urban community-based implementation of a teleophthalmology program in a largely underserved area identified referable DR in over 16% of the population. Consistent with published tertiary center cohorts, evaluation of the peripheral retina using UWFI suggested more severe DR in 11% of eyes. Ungradable image rates dropped dramatically with imager experience. These data emphasizee the value of a DR teleophthalmology program in such communities and the importance of ongoing quality assurance to achieve and maintain low ungradable image rate
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