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J. D. Cavallerano, P. S. Silva, J. K. Sun, A. M. Tolson, L. M. Aiello, L. P. Aiello; Effectiveness of a Telemedicine Eye Care Program in Promoting Access to Ophthalmic Care at the Joslin Diabetes Center. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4676.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the effectiveness of the Joslin Vision Network (JVN) diabetes telemedicine eye care program located in the endocrinology clinic of a diabetes-specific center for accessing patients otherwise not receiving eye care at that center.
Retrospective structured search queries of electronic medical records from 1/1/2006-10/31/2008 for all patients evaluated by JVN (JVN cohort) and subsequently referred for ophthalmic care at the Joslin’s Beetham Eye Institute (BEI) and a similar search of all patients seen within the same time period at both the BEI and Joslin endocrinology clinic who did not undergo JVN imaging (nonJVN cohort).
Of the 7,358 total patients imaged by JVN, 3,449 (47%) were subsequently referred to and examined at the BEI. Compared to 11,169 nonJVN patients, JVN patients were younger (median age 52y vs 57y; p<0.0001), male (56% vs 49%; p<0.0001), had shorter median diabetes duration (9y vs 14y; p<0.0001), more type 2 diabetes (57% vs 49%; p<0.0001), less hypertension (65% vs 70%; p<0.0001) and less dyslipidemia (68% vs 76%; p< 0.0001). Glycemic control, presence of renal disease, and use of ACE or angiotensin blockers were not significantly different between the groups. The JVN cohort also contained a significantly higher percentage of non-white patients as compared with the nonJVN group (22% vs 15%; p<0.0001) [2.8x more Asians (3.4% vs 1.2%) and 1.7x more Latinos (7.6 % vs 4.6 %)] JVN patients had less severe retinopathy severity [more no or mild NPDR (79% vs 64%; p=0<0.0001) and less PDR (9% vs 19%; P<0.0001)] but more DME (21% vs 16%; p<0.0001). The median BCVA in both groups was 20/20.
Among patients receiving diabetes care at a tertiary diabetes-specific academic medical center, an ocular telemedicine program was able to identify and promote eye care for a large, substantially different cohort from that already receiving eye care at that center. These patients were younger, more often minority, and with shorter diabetes duration and less severe retinopathy. Thus, even in a tertiary academic environment, a telemedicine program enhanced access to appropriate diabetes eye care, especially for minority patients with early ocular pathology, for whom timely ocular and medical management will be highly effective in preserving vision.
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