Telemedicine for Diabetic Retinopathy Screening for Well Insured Patients in a Non-Geographically Isolated Setting

Abstract

Purpose : In urban populations where ophthalmologists are accessible, the geographical barriers of diabetic retinopathy (DR) screening should be relatively low. Despite this, diabetic patients often do not attend recommended screening visits. Historically, teleretinal imaging has improved screening rates of patients in geographically restricted areas. This study examines the impact of telemedicine on insured diabetic patients who are not geographically isolated from specialists.

Methods : Retinal images were taken in six different primary care physician (PCP) offices within the greater Austin, TX area and uploaded to the cloud-based Intelligent Retinal Imaging Systems (IRIS). Patient data including age, gender, PCP clinic location, any ocular pathology, diabetic retinopathy, severity of DR and presence of diabetic macular edema (DME) was accessed from IRIS over a 12-month period (Sept 2015 to 2016). Patients requiring referral due to pathology were contacted by the reading center to schedule appointments with a retina specialist. The capture rate, defined as the number of patients requiring referral who actually attended their appointment, was calculated. Each PCP clinic was within 5 miles of an ophthalmologist.

Results : 3620 patients were screened. Period prevalence of DR was 20.7% (750/3620). Ocular pathology including DR, AMD, and glaucoma, was detected in 33.4% (1209/3620). Prevalence and severity of DR and presence of DME is shown in Figure 1. Though there were differences in rates of DR or DME across the six sites, they did not meet statistical significance. 371 (10.2%) required urgent referral and of these, the capture rate was 65.5% (240/371). Therefore, 3249 patients (89.8%) did not need further examination until next scheduled image.

Conclusions : Even for patients who reside in geographic proximity to an ophthalmologist, teleretinal diabetic screenings is effective. A large majority of patients screened did not require further ophthalmology examination. Our capture rate for patients requiring urgent referral is greater than previous reports in the literature. Direct contact from the reading center’s office to these patients immediately following identification of pathology is a likely contributing factor to increasing patient capture rate. Telemedicine may benefit a wide range of patients including those without geographic barriers.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.