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Kristina Holbrook, Kerry Cotter, Paul Andrew Yates; Comparison of two diabetic retinopathy screening program models within a single primary care practice. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5564.
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To evaluate factors that determine the effectiveness of tele-ophthalmic screening programs for diabetic retinopathy (DR) by comparing two successive implementations at a primary care practice that serves the largest population (N=2570) of adults with diabetes mellitus at the University of Virginia.
In 2006, a DR screening program was established using the Optos wide-field retinal imager (Optos Program). Digital images of each eye using the non-mydriatic, 200-degree retina view were obtained by multiple nurses at physician request and read by a UVA ophthalmologist in a time frame consistent with the patient’s ongoing consultations. Results were communicated to the ordering physician. The program was active until 2009, when the system was removed due to unsatisfactory outcome measures relative to cost-effectiveness. In September 2011, a revised DR screening program was established at UMA (DRS Program). A single medical assistant obtained one 45° macula-centered image of each eye using a refurbished non-mydriatic camera (Topcon TRC-45N). The images were read by an ophthalmologist. Results and ophthalmic follow-up recommendations were shared with the ordering physician and patient within 48 hours of screening. To evaluate program success, we compared number of patients screened, number of cases of DR, number of patients identified with other retinal pathology, and the ophthalmic follow-up visit compliance rate in patients with suspected DR.
The Optos Program screened 186 patients in 36 months and the DRS Program screened 1348 in 26 months. DR was detected in 29 (16%) patients in the Optos Program and 253 (19%) in the DRS Program. Positive screens (with DR) identified via the DRS Program were more compliant with their ophthalmic follow-up visit recommendation (71% compliance) than those identified via the Optos Program (34% compliance).
Multiple factors enabled the success of the latter program. The designation of a full-time nurse / photographer and integration of screening into the nursing workflow (a standing order is used) contributed to program success. Time associated with image transmission, review, and communication of results (< 48 hours) was decreased through the latter program. Directly involving the patient in the scheduling of the ophthalmic follow-up appointments contributed to the improved follow-up appointment completion rate.
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