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R.M. Davis, J. Pockl, K. Bellis; Improved Diabetic Eye Care Utilizing Telemedicine: A Randomized Controlled Trial . Invest. Ophthalmol. Vis. Sci. 2003;44(13):166.
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Purpose: Screening of diabetic patients for retinopathy may reduce the risk of vision impairment or blindness by 50%. Unfortunately less than 50% of diabetic patients obtain annual eye examinations. In addition, little is known about the patterns of care in rural and ethnic communities regarding diabetic eye care. Our hypothesis is that screening retina examinations performed in a primary care setting will improve examination rates. Methods: We conducted a randomized controlled trial comparing telemedicine-based retina examinations in a family physician's office to standard care in the offices of eye providers. The primary outcome was the frequency of eye examinations. Fifty-nine diabetic patients were randomized to two groups, Group 1 - telemedicine and Group 2 - standard eye care. Group 1 patients were asked to schedule a screening eye examination in their family physicians office at the Greeleyville Medical Center where a telemedicine system was linked to the Department of Ophthalmology. The Topcon non-mydriatic camera with IMAGEnet software was used for all cases. One drop of phenylephrine 2.5% was applied 15 minutes prior to each examination. Group 2 patients were asked to schedule an appointment with their eye care providers for a dilated eye examination. A list of eye care providers was given to those patients without a provider. Results: Of the 30 patients randomized to Group 1, twenty-three patients (77%) obtained screening eye exams via telemedicine. Of the 29 Group 2 patients (standard care), four patients (14%) scheduled eye appointments with eye care providers. Conclusions: Based on our small sample, telemedicine in a primary care setting increased the rate of screening examinations by 63%. Screening eye examinations in a rural family physician's office utilizing telemedicine may increase the frequency of annual examinations in diabetic patients. This approach may also be successful in decreasing preventable ocular morbidity thereby achieving savings in health care dollars.
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