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L. B. Walker, A. Dawson, M. E. Farber, J. D. Walker; Cost-Effective Screening for Diabetic Retinopathy Using Telemedicine in a Free-Clinic Setting. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2723.
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Less than 50% of uninsured patients with diabetes in the United States undergo recommended ocular evaluations for diabetic retinopathy. Retinal photography based telemedicine has been proven to be effective as a screening tool to identify patients at risk, but such systems are expensive and require a significant amount of infrastructure including hardware, software, and skilled technicians. We set out to determine the efficacy of inexpensive telemedicine-based techniques for screening for diabetic retinopathy in a free-clinic setting using personnel with no prior ophthalmic experience and with no ongoing financial support.
We under took a retrospective chart review of 476 free-clinic patients that had retinal photography when presenting for clinic visits over a 15 month period. These photos were uploaded to an electronic medical records system and read by retinal physicians at a private practice. Patients with potential vision threatening pathology were then brought into the retinal practice for evaluation and treatment.
339 (71%) had either no pathology or only minimal pathology requiring annual photographic screening. 51 (11%) had non-urgent pathology, such as mild nonproliferative retinopathy. These patients were assigned closer follow up and had photographs repeated more frequently. 27 (6%) had potentially urgent pathology and were referred to the retinal practice for further evaluation. Of these patients, 5 had proliferative retinopathy requiring laser. 17 other patients had macular edema; 5 had clinically significant disease requiring treatment.The costs were minimal. The camera was purchased largely with a grant from a charitable organization. The camera is easy to use and training was quickly performed with the assistance of a simple manual. The photographs were done by free clinic volunteers and the free clinic was responsible for contacting patients and arranging follow up. The physician time required was one to two hours a week and consisted of reviewing photographs on the internet and examining two to three additional patients per month.
Telemedicine-based screening for diabetic retinopathy is effective for detecting vision threatening diabetic retinopathy in a free-clinic setting. Such a system can be set up with relatively little cost and involves minimal time commitment on the part of physicians.
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