June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Point-of-Care Evaluation of Diabetic Retinopathy Using Ultrawide Field Imaging in a Teleophthalmology Program
Author Affiliations & Notes
  • Radwan Ajlan
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Paolo S Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Ophthalmology Department, Harvard Medical School, Boston, MA
  • Jerry D. Cavallerano
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Ann Tolson
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Jessica Rodriquez
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Sashida Rodriguez
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Dorothy Tolls
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Ophthalmology Department, Harvard Medical School, Boston, MA
  • Lloyd Paul Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Ophthalmology Department, Harvard Medical School, Boston, MA
  • Footnotes
    Commercial Relationships Radwan Ajlan, None; Paolo Silva, None; Jerry D. Cavallerano, None; Ann Tolson, None; Jessica Rodriquez, None; Sashida Rodriguez, None; Dorothy Tolls, None; Jennifer Sun, None; Lloyd Paul Aiello, Optos plc (R)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3966. doi:
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    • Get Citation

      Radwan Ajlan, Paolo S Silva, Jerry D. Cavallerano, Ann Tolson, Jessica Rodriquez, Sashida Rodriguez, Dorothy Tolls, Jennifer K Sun, Lloyd Paul Aiello; Point-of-Care Evaluation of Diabetic Retinopathy Using Ultrawide Field Imaging in a Teleophthalmology Program. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3966.

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

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Abstract

Purpose: To evaluate the ability of trained nonphysician retinal imagers to perform point-of-care diabetic retinopathy (DR) evaluation at the time of ultrawide field (UWF) retinal imaging in a teleophthalmology program.

Methods: Diabetic individuals received Joslin Vision Network protocol retinal imaging as part of their standard medical care in a specialty diabetes clinic. Imager training included a standardized 4 hours didactic and 12 hours of guided image review. Real time grading results were compared to results from masked standardized grading at a dedicated reading center.

Results: 3,978 eyes (1,989 patients) were studied. By reading center evaluation of UWF images, 3,769 eyes (94.7%) were gradable for DR, with 1,376 eyes (36.5%) having DR, and 580 eyes (15.3%) having referable DR (moderate nonproliferative DR or worse or diabetic macular edema). Compared to the reading center evaluation, real time point-of-care imager grading had a sensitivity of 95% (95%CI 0.94-0.97) and a specificity of 84% (95%CI 0.82-0.85) for identifying more than minimal DR. Sensitivity and specificity for detecting referable DR were 99% (95% 0.97-1.00) and 76% (95% 0.75-0.78), respectively. Only 3 (0.15%) patients with referable DR (3 patients with moderate NPDR) were not identified by imager evaluation. No cases of severe NPDR or worse or clinically significant macular edema were missed by the imagers.

Conclusions: Evaluation of UWF images by nonphysician imagers following established teleophthalmology program protocols had good sensitivity and specificity for detection of DR and identification of referable retinal disease. These data suggest that immediate evaluation by retinal imagers at the point-of-care might reduce reading center image grading burden by approximately 60% with the added benefit of rapid patient feedback.

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