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T. M. McClure, I. Swanson, K. Wooten, T. M. Becker, S. L. Mansberger; Proportion of Diabetic Retinopathy Found in Rural and Urban Populations of American Indian/Alaska Natives and Other Ethnicities Using Either a Telemedicine Protocol or Traditional Surveillance Techniques. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4421.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the proportion of diabetic retinopathy (DR) found in underserved rural and urban populations of American Indian/Alaska Natives (AI/AN) and other ethnicities using non-mydriatic retinal imaging and traditional surveillance techniques.
We performed a staged survival design by randomly assigning participants to one of two groups: Camera or Provider, and asked both groups to see an Eye Care Provider (ECP) annually. We also took retinal images of Camera group participants at least once per year, while Provider group participants received imaging only in the 3rd and 4th years of the study. We evaluated retinal images for DR and other ocular disease, and sent electronic reports to the sites for inclusion in patient charts; ECP evaluations were performed using traditional surveillance methods by local ECP’s. We used a predetermined scale of DR type, ranging from Stages 1 (Mild NPDR) to 5 (PDR), for all image and ECP evaluations.
We present data for 532 participants who have completed at least 1 year of the study [268 (50%) in the Camera group; 264 (50%) in the Provider group]. 243 (90.7%) Camera group participants had images evaluated, with 13 (4.9%) having images that were too dark or otherwise unreviewable; 53 (19.8%) of them also had an ECP exam. 69 (26.1%) of Provider group participants had an ECP exam. Based on image evaluations in the more damaged eye in the Camera group, we found 31 (11.6%) had Mild NPDR; 7 (2.6%) were Moderate; and 3 (1.1%) had PDR. In this group, ECP evaluations found 6 (2.2%) with Mild NPDR; 5 (1.9%) with Moderate; and 2 (0.7%) with PDR [Undetermined=1 (0.4%)]. In the Provider group, ECP evaluations found 11 (4.2%) with Mild NPDR; 8 (3%) with Moderate; 2 (0.8%) with Severe; and 2 (0.8%) with PDR [Undetermined=3 (1.1%)].
Retinal imaging using a non-mydriatic camera increases the proportion of diabetics who obtain screening eye exams. Most diabetics in this sample did not have levels of diabetic retinopathy that required ophthalmic intervention.
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