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MICHAEL BENNETT; Initial Results of the Diabetic macular edema and diabetic retinopathy Identification by screening (telemed) with Verified automatEd Retinal photography (DIVER) Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1432.
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Evaluate the process and results of 500 patients screened for diabetic eye disease through collaboration between Retina Institute of Hawaii and Primary Care practices utilizing a program which included staff training, automated fundus photography and telemedicine review techniques.
Retina Institute of Hawaii collaborated with 5 primary care groups to develop a system to screen patients with diabetes for eye disease. Primary Care practices were trained to use Nidek Automated Fundus Photo Cameras on taking photos, uploading and transmitting images. Images received were read by a Retina Specialist and a report returned to the collaborating practice. Patients were counseled on the results and the importance of annual visits to an eye doctor. Patients were assessed at 6 months to see if a combination of photo/ counseling resulted in better documented diabetic care (A1C) and or an annual visit to an eye doctor.
After staff training, 500 patients with diabetes who had not had a dilated eye exam in the past year were included in the study. At baseline, 425/500 (85%) reported they had not seen an eye doctor before. Grading of the photos by our Retina Specialists revealed eye disease in 155/500 (31%) with 62/500 (12.4%) having diabetic retinopathy (DR) of which 27% (17/62) of these also had diabetic macular edema (DME). Other eye diseases detected (in 93/500 (18.6%) included hypertension, AMD, vitreous detachment, branch retinal occlusion and presumed toxoplasmosis. After counseling, a written report and photos at the 6 month assessment, 272/ 500 (54.4%) reported they had seen an eye doctor and the scheduled visit occured quickly within 14-23 days on average. Patients and primary care practices also showed improvement in their overall diabetes control 319/ 500 (63.8%) having a HgA1C in the chart at baseline that increased to 481/500 (96.2%) at the end of the study.
Initial results revealed a great need for intervention with (85%) of diabetes patients having never seen an eye doctor before. Some form of eye pathology appeared evident in roughly one-third (31%) of 500 patients. Additionally, 12% had evidence of diabetic retinal involvement. The program’s success seems to include an increase in diabetic and associated educational awareness, documented hemoglobin A1c and annual eye care visits.
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