June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Four-year experience of tele-ophthalmology for diabetic retinopathy screening in San Francisco, CA
Author Affiliations & Notes
  • Christos Theophanous
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Jay M Stewart
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Armin Afshar
    Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Christos Theophanous, None; Jay Stewart, None; Armin Afshar, None
  • Footnotes
    Support  That Man May See, Inc., San Francisco, CA; An unrestricted grant from Research to Prevent Blindness, New York, NY
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2899. doi:
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      Christos Theophanous, Jay M Stewart, Armin Afshar; Four-year experience of tele-ophthalmology for diabetic retinopathy screening in San Francisco, CA. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2899.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Diabetic retinopathy (DR) is a leading cause of vision loss in adults. We performed a cross sectional analysis of a pilot DR screening program conducted by the San Francisco Department of Public Health from 2012 – 2016 to determine the prevalence of diabetic retinopathy and other comorbid eye conditions in a diverse, urban patient population.

Methods : Screened patients were adults aged 18 and over referred from two community health centers and the San Francisco General Hospital primary care clinics with diagnosis of Type II diabetes mellitus. Color fundus photographs were taken with a non-mydriatic camera (Optos Daytona, Optos Plc., Dunfermline, Scotland, UK). DR and other ophthalmic disease was graded by an optometrist or ophthalmologist according to the Joslin Vision Network (JVN) DR scale. The outcome measures were presence or absence of diabetic retinopathy, grade of retinopathy, and other ophthalmic disease such as glaucoma suspect, cataract, age related macular degeneration or retinal vein occlusion. Data was analyzed in STATA (College Station, TX).

Results : 4,925 patients were screened; 1458 (29.6%) had DR, 3,308 (67.2%) had no retinopathy and 159 (3.2%) images were un-gradeable due to poor image quality or media opacity). Of the DR patients, 1,066 (73%) had mild non-proliferative (NPDR) 251 (17%) had moderate NPDR, 53 (4%) had severe NPDR, 88 (6%) had proliferative DR and 71 (5%) had diabetic macular edema. 483 (10%) of all screened patients were glaucoma suspects due to optic disc appearance. 153 (32%) of the glaucoma suspects also had DR; 330 (68%) had no DR. 207 (4%). 29 (1%) patients had retinal vein occlusions and 12 (0.2%) had age related macular degeneration. 3448 (70%) of patients were scheduled for annual follow up. 1481(30%) of patients were scheduled for an ophthalmology exam within 1-6 months for detected eye diseases.

Conclusions : The prevalence of diabetic retinopathy among type II diabetics screened in the SFDPH program was 30%, with 159 (3%) having diabetic macular edema or proliferative disease, requiring prompt ophthalmic treatment. 10% of all screened were glaucoma suspects, two thirds of whom had no detectable diabetic retinopathy. 30% of patients screened required further ophthalmic investigation within 1-6 months. Cost-benefit analysis of the program is ongoing and will be presented.

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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