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U.S. Rao, B. Barahimi, C. Recchia, L.M. Merin, K. Guentri, A. Chomsky, F. Recchia; Incidence And Nature Of Referrals Among Diabetic Patients Enrolled In A Fundus Photographic Screening Program . Invest. Ophthalmol. Vis. Sci. 2006;47(13):980.
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The use of telemedicine to screen for diabetic retinopathy has been widely reported. The purpose of this study is to determine the incidence and nature of referrals to ophthalmologists based on fundus photographic screening of diabetic patients.
Consecutive reports of all diabetic patients enrolled in a photographic screening program for diabetic retinopathy at the Tennessee Valley Veterans Administration Healthcare System between June 2003 and March 2005 were reviewed. The reports were based on the analyses of 2 sets of monoscopic, 45–degree photographs centered on the macula and optic nerve. The records were reviewed for the presence of findings suggestive of diabetic retinopathy as well as any other ocular pathology.
This study included 4942 patients; 1897 (38%) of these patients were referred to see an ophthalmologist or primary care physician. 431 patients (9%) were considered to be urgent referrals (to be seen within two weeks.) Among these patients, clinically significant macular edema (CSME) accounted for the most referrals (n= 241; 56%) followed by proliferative diabetic retinopathy (PDR) (n= 96; 22 %.) 1466 patients (30%) were considered to be nonurgent referrals (to be seen within three months.) Among these patients, unexplained decreased visual acuity (≤20/50) accounted for the most referrals (n= 783; 53%) followed by optic nerve cupping suggestive of glaucoma (n= 578; 39 %.) 3045 patients (62%) did not have any pathology requiring a referral. These patients were advised to be rescreened in one year.
In a nonophthalmic setting, fundus photographic screening may identify the severity of diabetic retinopathy as well as nondiabetic ocular conditions. Such a screening program may facilitate access to, and appropriate triage for, the eye care of diabetic patients.
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