March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Cost-Effectiveness of Telemedicine Screening for Diabetic Retinopathy
Author Affiliations & Notes
  • Cory VanAlstine
    Devers Eye Institute, Portland, Oregon
  • Steven M. Kymes
    Ophthal/Vis Science, Washington Univ Sch of Med, St Louis, Missouri
  • Dustin Stwalley
    Washington University School of Medicine, St. Louis, Missouri
  • Christina R. Sheppler
    Discoveries in Sight,
    Devers Eye Institute, Portland, Oregon
  • Steven L. Mansberger
    Devers Eye Institute, Portland, Oregon
  • Footnotes
    Commercial Relationships  Cory VanAlstine, None; Steven M. Kymes, Allergan (C), Bayer (C), Genentech (F, C), Pfizer (F, C), TreeAge (C); Dustin Stwalley, None; Christina R. Sheppler, None; Steven L. Mansberger, None
  • Footnotes
    Support  CDC Cooperative Agreement Number 1-U-48-DP-002673
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 1402. doi:
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      Cory VanAlstine, Steven M. Kymes, Dustin Stwalley, Christina R. Sheppler, Steven L. Mansberger; Cost-Effectiveness of Telemedicine Screening for Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1402.

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

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Previous studies have demonstrated that using telemedicine to provide diabetic retinopathy screening exams is cost-saving from the perspective of the provider. We evaluate the cost-benefit of this method from the perspective of the patient, using time as the metric for cost.


We developed a cost-effectiveness survey, which was administered to participants enrolled in a clinical trial. In this trial, screening for diabetic retinopathy was performed using either a nonmydriatic camera placed at the primary care clinic, or by the participant’s eye care provider. Retinal images were taken by a technician and forwarded electronically to an ophthalmologist for evaluation. Imaged participants found to have moderate diabetic retinopathy or worse were referred to an eye care provider for follow up care. We modeled this care process (see figure for model) and compared the time reported by patients using the telemedicine model to the time to obtain screening from their eye care provider. From this we estimated the break-even pretest probability of Diabetic Retinopathy that would make screening by the primary care clinic cost-saving from the patient’s perspective.


Participants (n=127) were 47% male and had a mean age of 56 years. In regard to transportation, 61% of participants drove themselves and 28% had someone else drive them to their appointment (the balance walked or used public transportation). The median time to travel to the primary care clinic and obtain a diabetic retinopathy screening image was 40 minutes; the median travel time to and length of an eye care provider visit was 60 minutes. The model showed a cost-savings from the patient perspective, so long as the pretest probability of moderate or worse diabetic retinopathy was less than 33%. Data from the clinical trial shows that 7.7% of participants were diagnosed as having moderate or worse diabetic retinopathy.


Our preliminary results demonstrate that in this population, the use of telemedicine to provide diabetic retinopathy screening exams is time saving from a patient perspective. Future work will examine financial impact, long term time savings, the impact of incidental ocular findings, and the importance of patient specific pretest vision status.  

Clinical Trial: NCT01364129

Keywords: diabetic retinopathy • diabetes 

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