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J. Martinez, L. Wu; Telemedicine Screening for Diabetic Retinopathy in a Costa Rican Population: A Pilot Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4431.
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To report our initial experience screening for diabetic retinopaty with telemedicine.
A non-mydriatic topconTRCNW6S fundus camera was set up at the Clorito Picado Clinicin San Jose, Costa Rica, a district level public clinic. All outpatient diabetic patients referred to the opthalmology department between April and October 2008 were screened with single field 45 degree digital retinal images centered on the fovea. Data collected included age, insulin use, gender, diabetes duration and average time wait for appointment. Photos were reviewed by a retinal specialist and diabetic retinopaty was classified according to the international clinical retinopathy disease severity scale.
A total of 1048 patients were screened, 13,8% of patients required pupillary dilation for an adequate image to be taken and 7,6% of the images were unreadable. The average age was 60,5 years old, women compromised 61% of the population, the average duration of diabetes was 7,0 years and 70,2% did not use insulin. The average wait for a telemedicine appointment was 47,5 days. The prevalence of diabetic retinopathy in this population was 14,8%. Of this, 5,6% had mild non proliferative diabetic retinopathy, (NPDR), 3,7% had moderate NPDR, 4,8% had severe NPDR, 0,6% had proliferative diabetic retinopathy and 1,8% had macular edema. Of all the screened patients, 173 (16,5%) had to be seen by an opthalmologist.
Telemedicine screening for diabetic retinopathy appears to be a viable option for the improvement of screening for diabetic retinopathy in Costa Rica, only 16,5% of patients needing a regular exam by an opthalmologist.
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