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Hang Pham, Sweta Kavali, Levent Akduman; Detection of Nondiabetic Retinal Findings Using Remote Imaging in Telemedicine. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3118.
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© ARVO (1962-2015); The Authors (2016-present)
Remote photography with telemedicine has the potential to deliver cost-effective and accessible screening for retina pathology. Telemedicine has been widely used to screen for diabetic retinopathy (DR)1,2. The technology has also been used to screen and classify age-related macular degeneration (AMD) and retinopathy of prematurity3,4. A previous study has estimated that nondiabetic retinal findings can be identified in approximately 26-40% of patients with diabetes5. The goal of the study is to examine the detection of DR and nondiabetic ocular pathology using telemedicine to determine which patients should be referred to an ophthalmologist.
Fundus images of patients with diabetes mellitus (DM) were taken with a nonmydriatic, noncontact fundus camera in primary care offices during their comprehensive visits. Eyes were dilated only if image quality was suboptimal. Images then were sent to qualified graders (retina specialists) for screening of DR, other retinal diseases, or suspected ocular pathology through telemedicine.
4830 eyes of 2443 patients were imaged over 6 months from offices of 134 primary care physicians. Images of 207 eyes were excluded due to poor quality. A total of 4623 eyes were graded out of 4830 eyes (95.7%). These images were graded by two retina specialists. 400 patients (16.3%) were found to have various degrees of DR. Among patients with DR, 267 patients were graded as mild non-proliferative diabetic retinopathy (NPDR), 94 patients with moderate NPDR, 13 patients with severe NPDR, and 26 patients with proliferative DR. Besides DR, 498 patients (20.4%) were found to have or suspected to have nondiabetic ocular pathology to justify referral to an ophthalmologist. The nondiabetic ocular pathology included hypertensive retinopathy (30 patients), epiretinal membrane (55 patients), macular hole (4 patients), cataract (35 patients), glaucoma (91 patients), dry AMD (139 patients), wet AMD (12 patients), retinal vein occlusion (12 patients), and other ocular diseases (193 patients). Other ocular disease included optic atrophy, branch retinal artery occlusion, ischemic optic neuropathy, choroidal nevus, and ocular histoplasmosis.
Telemedicine screening of patients with DM may identify various degrees of diabetic retinopathy but also other significant ocular or systemic conditions that may have serious impact on patients’ ocular health and systemic health and life.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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