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Gilberto Zamora, Javier Lozano, Richard VanNess, Sheila C Nemeth, Omar Meza, Eduardo Martiñon, Elizabeth McGrew, Peter Soliz; Teleretinal Screening in Mexico: Second Year of a Pilot Project at a Comprehensive Diabetes Care Clinic in Monterrey, Mexico and Preliminary Results on Clinical Outcome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5331.
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To provide an update on our pilot project to provide teleretinal screening services in Monterrey, Mexico and show preliminary results on clinical outcome from a comprehensive diabetes care model.
This is the second year of a pilot project between VisionQuest Biomedical and Clínicas del Azúcar to provide teleretinal screening services to the clinic’s patient members, who all have diabetes. Patients are imaged using a teleretinal screening system for assessment of diabetic retinopathy as standard of care. The retinal camera is a Canon CR 2, 45-degree, non-mydriatic camera. The imaging protocol includes two images of the retina, one macula-centered and one optic-disc-centered, and one anterior image, for each eye. Images are read in New Mexico within 48 hours according to the International Clinical Diabetic Retinopathy Grading Scale. The care model includes onsite consultation with a psychologist, a nutritionist, and a chronic disease specialist. This model also includes onsite retina, foot, and blood screenings, as well as workshops, exercise sessions, and access to diabetes-friendly groceries. Follow up with ophthalmology for high-risk cases is arranged by the clinic. Clinical outcome is assessed as comparison of levels of HbA1C every three months to a standard of 7% with individual goals set between 6.5% and 8%.
Of the 815 cases the distribution for the two years (377 in year 1) has remained constant at 56% female and 44% male. Disease level has been 31% with no DR, 67% with DR and 6% unreadable. DR findings: 10% Mild NPDR, 20% Moderate NPDR, 3% Severe NPDR, 3% PDR, 4% Probable CSME, 5% Laser scars. Other Findings: 18% HTN Retinopathy, 7% Glaucoma suspect, 5% Cataracts, 4% Drusen. Referral to Ophthalmology: 285 Clinical outcomes: 80% of patients improved their levels of HbA1C while 60% reached their individual goal levels.
The second year of our pilot project shows sustained interest in this care model and stable findings. Clinical outcomes are comparable to those expected from endocrinology care. In 2014, Clínicas del Azúcar expects to open 5 to 7 clinics. All clinics will implement VisionQuest’s screening service.
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