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O.M. Ceron, E.P. Simmons, L. Robles, E. Garcia, J. Cavallerano, N. Timothy, R. Calderon, A.E. Caballero, L.P. Aiello; Integration of Ocular Telemedicine and Specialty Diabetes Care in a Latino Population . Invest. Ophthalmol. Vis. Sci. 2006;47(13):996.
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© ARVO (1962-2015); The Authors (2016-present)
Joslin’s multidisciplinary, comprehensive Latino Diabetes Initiative incorporated Joslin Vision Network (JVN) ocular telemedicine to evaluate diabetic retinopathy (DR)
Evaluate integration of ocular telemedicine within Joslin’s Latino Diabetes Initiative
Retrospective chart review and JVN retinal imaging of 113 patients from 2002–5
Of the 113 patients, 59 (52%) were women, 87% had type 2 diabetes mellitus (DM), mean age was 52+13 yrs, mean duration of DM was 11+10 yrs and mean HgbA1c was 8.6+2.0%. Time since the last eye exam ranged from 1 week to no prior exam (mean of 17 months); 34% of patients reported no eye exam within 12 months. Of the 226 eyes imaged, 115 (51%) had DR, 95 (42%) had no DR, and 16 (7%) were ungradable for level of DR. Of the 115 eyes with DR, 73 (32.3%) had mild–moderate nonproliferative DR (NPDR), 10 (4.4%) had severe NPDR, 1 (0.4%) had very severe NPDR, 2 (0.9%) had early proliferative DR (PDR) and 1 (0.4%) had high–risk PDR. Prior scatter photocoagulation was identified in 20 (8.8%) eyes. Severity of DR was ungradable in 8 (3.5%) eyes due to media or small pupils. No diabetic macular edema (ME) was observed in 180 (79.6%) eyes, 5 (2.2%) had ME not clinically significant (CSME), 9 (4.9%) had CSME and 37 (16.4%) were ungradable for ME. There was glaucoma suspicion due to asymmetry or cupping in 21 (9.3%) patients. In patients with no eye exam within 12 months, 7 eyes had severe NPDR, 1 very severe NPDR, 3 had ME and 8 were glaucoma suspects. Medical data were available for 104 patients, of whom 24.7% used insulin, 44.2% oral agents, 27.4% both, and 3.5% diet/exercise alone. No albuminuria was present in 69.9%, 24.7% had microalbuminuria, 4.1% had macroalbuminuria and 1.4% were on dialysis. Average body mass index was 31.3+7.3. Mean total cholesterol was 190, LDL was 114, HDL was 44 and triglycerides were 200. Mean blood pressure was 126 systolic and 72 diastolic. 52% of patients had peripheral neuropathy.
Retinal evaluation using the JVN was successfully incorporated into the Latino Diabetes Initiative, identifying at least one–third of patients who had not received minimal suggested eye care of whom 50% had sight–threatening disease. Thus, retinal telemedicine in programs serving high–risk underserved populations enhances access to appropriate diabetic eye care and should result in a subsequent reduction of visual impairment.
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