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I.E. Zimmer–Galler, M.F. Goldberg, R. Zeimer; Implementation of DigiScope screening for diabetic retinopathy in the primary care physician's office. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4121.
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Purpose: In spite of the known benefits of ophthalmic evaluation and treatment, half or more of diabetic patients do not receive recommended eye examinations. The offices of primary care physicians (PCP) are likely the most efficient environments for screening efforts. However, on average, PCPs anticipate only one diabetic patient per day. This renders the implementation of existing telemedicine systems impractical and prohibitively costly for screening in this setting. We have developed a screening technology, the DigiScope, designed for such an environment. Methods: The DigiScope camera, operated by office staff, acquires digital fundus images and estimates visual acuity. The data, automatically transmitted to a reading center, are reviewed by trained readers to determine if the patient needs referral to an ophthalmologist. In the PCPs’ offices, diabetic patients who had not undergone an eye examination in the past year were screened with the DigiScope. They were informed that the procedure does not replace a comprehensive eye examination. Patients with more than a few microaneurysms or hemorrhages, estimated abnormal visual acuity, or unreadable images were referred. Referral was deemed ‘urgent’ for patients with sight–threatening retinopathy. This report is based on the results of DigiScope implementation in several sites between October 1, 2002 and March 31, 2003. Results: A total of 2,771 diabetic patients, 20 to 93 years of age (mean 60), underwent DigiScope screening. Thirty one percent were referred (17% – retinopathy; 3% – sight threatening retinopathy; 11% – ungradable images), and 69% did not require referral. The major reasons for ungradable images were: inadequate fixation (3.0%), operator error (2.9%), pupil size (1.7%) and cataract (0.5%). The ungradable rate was 2% for patients younger than 70 years of age. The frequency of referral was maximal at age 30 years. Some referrals (2.3 %) were not due to diabetic retinopathy, but were based upon observation of other retinal diseases. The financial aspects of screening with the DigiScope will be discussed. Conclusions: This study indicates that implementation of the DigiScope in the primary care setting is practical and allows screening of diabetic patients who are otherwise not receiving annual eye examinations.
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