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Richard VanNess, Gilberto Zamora, Sheila C. Nemeth, Elizabeth McGrew, Son Nguyen, Erika Harding, Kathleen Colleran, Jeannie Concha, Wendall C. Bauman, Jr., Peter Soliz; Retinal Screening In New Mexico And South Texas: Investigating Three Different Delivery Models. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2885.
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Retinal screening of people with Type 2 diabetes has been shown to identify subjects at risk for sight-threatening visual loss. Utilizing digital non-mydriatic retinal cameras along with internet access allows for deployment of retinal screening systems within diverse screening environments. We implemented retinal screening in rural and urban New Mexico and South Texas to study the effectiveness of screening within 3 unique health care delivery models.
Our first model is represented by CommuniCare Health Centers in southwest Texas, a community-based health care facility where primary care physicians refer patients for retinal screening. The second model, Project ECHO, is a university-based outreach program which uses a network of community healthcare workers in rural New Mexico to refer patients for retinal screening at clinics throughout the state. The third model, Project HOPE, uses a self-contained mobile clinic to provide retinal screenings at healthcare events throughout New Mexico. Our imaging protocol uses a Canon 45-degree non-mydriatic camera to take disc centered and macula centered images. Cases are uploaded to a HIPAA compliant/FDA cleared picture archival communication system Cases are graded online using a standardized reading template by optometrists and ophthalmologists utilizing the International Classification of Diabetic Retinopathy Scale.
Ratios of abnormalities and diabetic retinopathy to total number of cases were highest for the CommuniCare model. Project HOPE had the highest incidence of inadequates but the lowest ratio of DR cases.
The CommuniCare model has demonstrated the highest incidence of findings of our three models, where a primary care physician refers patients to retinal screening. This may provide support to the need of specialty services in underserved populations. Project HOPE includes more individuals from the general population who are concerned about monitoring their own health. A significant factor affecting the efficacy of the models is the skills of the photographers.
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