Abstract
Introduction: :
Joslin’s multidisciplinary, comprehensive Latino Diabetes Initiative incorporated Joslin Vision Network (JVN) ocular telemedicine to evaluate diabetic retinopathy (DR)
Purpose: :
Evaluate integration of ocular telemedicine within Joslin’s Latino Diabetes Initiative
Methods: :
Retrospective chart review and JVN retinal imaging of 113 patients from 2002–5
Results: :
Of the 113 patients, 59 (52%) were women, 87% had type 2 diabetes mellitus (DM), mean age was 52+13 yrs, mean duration of DM was 11+10 yrs and mean HgbA1c was 8.6+2.0%. Time since the last eye exam ranged from 1 week to no prior exam (mean of 17 months); 34% of patients reported no eye exam within 12 months. Of the 226 eyes imaged, 115 (51%) had DR, 95 (42%) had no DR, and 16 (7%) were ungradable for level of DR. Of the 115 eyes with DR, 73 (32.3%) had mild–moderate nonproliferative DR (NPDR), 10 (4.4%) had severe NPDR, 1 (0.4%) had very severe NPDR, 2 (0.9%) had early proliferative DR (PDR) and 1 (0.4%) had high–risk PDR. Prior scatter photocoagulation was identified in 20 (8.8%) eyes. Severity of DR was ungradable in 8 (3.5%) eyes due to media or small pupils. No diabetic macular edema (ME) was observed in 180 (79.6%) eyes, 5 (2.2%) had ME not clinically significant (CSME), 9 (4.9%) had CSME and 37 (16.4%) were ungradable for ME. There was glaucoma suspicion due to asymmetry or cupping in 21 (9.3%) patients. In patients with no eye exam within 12 months, 7 eyes had severe NPDR, 1 very severe NPDR, 3 had ME and 8 were glaucoma suspects. Medical data were available for 104 patients, of whom 24.7% used insulin, 44.2% oral agents, 27.4% both, and 3.5% diet/exercise alone. No albuminuria was present in 69.9%, 24.7% had microalbuminuria, 4.1% had macroalbuminuria and 1.4% were on dialysis. Average body mass index was 31.3+7.3. Mean total cholesterol was 190, LDL was 114, HDL was 44 and triglycerides were 200. Mean blood pressure was 126 systolic and 72 diastolic. 52% of patients had peripheral neuropathy.
Conclusions: :
Retinal evaluation using the JVN was successfully incorporated into the Latino Diabetes Initiative, identifying at least one–third of patients who had not received minimal suggested eye care of whom 50% had sight–threatening disease. Thus, retinal telemedicine in programs serving high–risk underserved populations enhances access to appropriate diabetic eye care and should result in a subsequent reduction of visual impairment.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: prevalence/incidence