Frequency and severity of diabetic retinopathy detected during tele-ophthalmic screening, among non-compliant patients

Abstract

 

Purpose

 

To determine the frequency and severity of diabetic retinopathy (DR) in adults with type I and II diabetes mellitus, who previously had an ophthalmic exam, subsequently missed their recommended follow-up eye exam, and then underwent tele-ophthalmic screening for DR within their primary care physician office.

 

Methods

 

Over 6 months, approximately 600 patients with diabetes underwent tele-ophthalmic screening for diabetic retinopathy at University Medical Associates (UMA), a primary care practice within the University of Virginia (UVA) Health System. A random subset of these patients (N=109) was selected for further evaluation. Of these patients, 57 (52%) were identified as having completed a previous dilated eye exam at the UVA Eye Clinic. For the 57 patients, a subsequent ophthalmic follow-up exam was recommended to be scheduled within 4-12 months, but was not completed. Patients who did not complete a follow-up eye exam with 12 months of their prior eye exam were classified as non-compliant. The frequency and severity of DR in the non-compliant group was compared to the compliant group (had completed a dilated eye exam within the prior 12 months).

 

Results

 

57 patients who completed tele-ophthalmic screening had previously had a dilated eye exam at the UVA Eye Clinic. The median number of months between the last dilated eye exam and screening for DR was 18, and the average number of months elapsed was 23. 12 (21%) patients were determined to have some evidence of DR, and 1 (1.8%) patient was determined to have proliferative DR. In this limited data set there was no clear trend towards more severe stages of DR in non-compliant patients (> 12 months since last eye exam) as compared to compliant patients (< 12 months from their last eye exam) (Table 1).

 

Conclusions

 

Non-compliant patients undergoing tele-ophthalmic screening for diabetic retinopathy, who have previously received an eye exam, and are now beyond their recommended follow-up for eye exam, do not necessarily have more severe stages of retinopathy or more diabetic retinopathy overall. A further study is needed to confirm these findings with a larger subject population and sub-classification of compliant and non-compliant patients according to degree of diabetes control.

 

 

Table 1. Frequency and severity of DR among patients seen at the UVA Eye Clinic who then completed a tele-ophthalmic screening for DR

 

Keywords: 499 diabetic retinopathy • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower