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Hugo Valencia-Santiago, Miguel Vazquez, Ellery Lopez-Star, Charles Van-Lansingh, Veronica Romero, Ximena Mira, Renata Garcia Franco; Staging of diabetic retinopathy in a sample of patients in Mexico through a reading center.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2904.
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To examine the rate and types of DR identified through a telemedicine screening program using a non-mydriatic camera, as well as the rate of other ocular findings at rural clinics in Mexico.
This is an ongoing prospective longitudinal study. Previous informed consent was obtained from patients prior screening and assessment. A questionnaire including the ophthalmological and systemic antecedents was filled, visual acuity was performed, along with two non-mydriatic ocular fundus photographs per eye. Trained/certified readers at Singapore Eye Research Institute (SERI) read and evaluated images using the National Health Services DR grading. The intra-rater kappa coefficient for readers with respect to DR findings was 0.72 with 88.8% agreement. The inter-grader kappa coefficient for DR findings was 0.60 (95% CI 0.51-0.73) with agreement of 84.1%. Readers assigned preliminary grades within 24 hours of image upload. Ocular pathology other than DR was recorded.
A total of 5628 persons participated in the screening program across sites. 4803 (85.34%) reported having DM, while 825 (14.66%) reported not having a diagnosis of DM. We evaluated 1650 eyes of patients without DM (14.66%) and 9606 eyes of patients with DM (85.34%). Of 1650 eyes of patients without DM, 1466 eyes (88.84%) were gradable and 184 eyes (11.15%) were no-gradable. Of 9606 eyes of DM patients, 7812 eyes (81.32%) were gradable and 1794 eyes (18.67%) were no-gradable. Of gradable eyes of patients with DM; 6482 eyes (82.92%) did not present RD data and 1330 eyes (17.02%) had some RD signs. 561 eyes (7.18%) presented some sign of diabetic maculopathy. Of the non-diabetic group, RD damage was identified in 15 patients (1.81%). Within the group of patients with DM, 898 (18.69%) patients had RD damage, of which 49.77% had bilateral damage. A recommendation was made for evaluation by diabetic maculopathy and diabetic retinopathy in 669 patients (13.92%) with DM.
The prevalence of diabetic retinopathy is high in the study population. There are undiagnosed cases of DM that can be detected through ocular fundus photography. As a technology in development, distance reading and evaluation centers have the potential to be efficient and cost-effective in providing health services to large geographic areas and unobserved populations.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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