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A. Pirbhai, T. G. Sheidow; The AMD Telescreening Project: Breaking Down the Barriers to Access in Ontario. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2395.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the initial experience of using a teleophthalmology screening program for AMD in Ontario. To also evaluate the effectiveness of screening patients deemed high risk for wet AMD, and establish benchmark data for time to treatment through the use of teleophthalmic screening over conventional referral methods in a tertiary retinal referral practice.
This is a prospective study of patients referred to a referral practice through a newly established teleophthalmology screening system. Data was collected prospectively on patients screened through the AMD Telescreening Project to determine wait times to consultation and treatment, as well as association between final clinical diagnosis and telescreening diagnosis. An historical cohort population of all AMD referrals to the Ivey Eye Institute within a 6 month period prior to implementation of Telescreening was established. Wait times were compared between the retrospective cohort and telescreening group.
A total of 209 images were uploaded through the secure teleophthalmology server for screening. 113 images were graded as Dry AMD/High Risk Dry AMD, 57 as wet AMD/query wet AMD, 3 as disciform, 23 were ungradeable and 13 were given another diagnosis. A total of 90 patients were deemed as requiring formal evaluation by a vitreoretinal surgeon with or without angiogram. A total of 86 patients were evaluated clinically. Of the 52 clinically evaluated and screened as having wet AMD, 38 (73.1%) were found to actually have wet AMD. Of 18 patients screened as dry AMD and evaluated formally, 15 (83.3%) were truly dry and 3 were found to have wet changes. As a percentage of new referrals, non-treatable disease (dry only, disciform or other diagnosis) comprised 43.0% of the patient referrals compared with 58.1% according to the retrospective cohort. The mean wait time to clinical evaluation from time of referral (ie. image upload vs. conventional fax/phone referral) was 19.98 ± 1.68 days and 51.69 ± 7.81 days, respectively showing a difference of 31.72 ± 6.78 days (p < 0.0001). The mean wait time from telescreening referral and conventional referral to treatment was 19.44 ± 2.38 days and 30.95 ± 4.56 days, respectively. The difference was 11.51 ± 4.67 days (p = 0.0164).
Compared to conventional referral methods, telescreening for age-related macular degeneration offers patients shorter wait times to vitreoretinal evaluation and shorter wait times to treatment. Telescreening in AMD also streamlines clinical practices with a higher percentage of patients for whom treatment may be of benefit.
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