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A. Erginay, P. Massin, A. Chabouis, Jr., D. Cohen, Z. Victor, L. Nicolon, A. Ben Mehidi, C. Viens Bitker, A. Gaudric, OPHDIAT Group; A Telemedical Network (OPHDIAT ®) to Screen for Diabetic Retinopathy in Paris Area . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3857.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy (DR) is a main cause of visual impairment in most industrialized countries. Nonmydriatic fundus photography is a valid, alternative method to ophthalmosocopy to screen for DR. After two pilot studies demonstrating the feasability of telemedecine to screen for DR in both hospital and primary care settings, we developed a regional telemedical network, OPHDIAT, designed to facilitate access of patients with diabetes to regular annual screening, while saving medical time.
OPHDIAT comprises peripheral screening centers equipped with non mydriatic cameras, where fundus photographs are taken by technicians, combined with telemedical linkage to a reference center where ophthalmologists grade the images. Presently, 12 screening centers in Ile de France are linked to OPHDIAT, including nine DR screening centers located in diabetology departments of nine different hospitals, one DR screening centre located in northern Paris and placed at the disposal of general practitioners and one in Orne area and one located in a prison setting.The access to the OPHDIAT Network is secured by the use of the « Health Professional Card» and all the data are protected by a 128 bit–encryption.
Between September 1st 2004 and August 31th 2005, 3950 DR screening examinations were performed . Patients' mean age ± SD was 55 ±14.5years (range : 17 to 91). The mean± SD duration of diabetes was 12.4 ± 9.2 years (range: 0 to 48). Retinal photographs were ungradable in at least one eye in 465 eyes (12 %). Diabetic retinopathy was detected in 926 patients (23.5%). Among them, 138 patients (3.5%) had undiagnosed severe diabetic retinopathy requiring urgent referral to an ophthalmologist for laser treatment (severe nonproliferative or proliferative DR, or macular oedema). After the screening examination, 1205 patients (30 %) were referred to an ophthalmologist, either for DR , cataract and/or ungradable photographs.
Fundus photography combined with telemedecine has the potential to improve regular annual screening for DR. Telemedecine has the major advantage of increasing patient access to health care services, while saving medical time. Pupil dilatation will be probably used in the future in older patients to decrease the rate of ungradable images.
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