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Miel Sundararajan, Ronald Gentile, Sophia Saleem, Meenakashi Gupta; Evaluation of a diabetic retinopathy telemedicine screening program in a metropolitan primary care setting. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1049.
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Diabetic retinopathy is the leading cause of blindness among working-age adults in the United States. Swift diagnosis and treatment is known to vastly reduce vision loss. Despite recommendations for at least yearly ophthalmic examinations in Type 2 diabetics, estimates establish that approximately 40% of diabetics eschew their annual eye exams. Interest in using telemedicine screenings to improve detection of diabetic retinopathy is rising. A retrospective review of a diabetic retinopathy telemedicine screening program undertaken in a metropolitan primary care center in New York City is presented.
Nonmydriatic fundus images of diabetic patients were obtained by medical assistants in the primary care setting using a Topcon NW 400 camera. Images were analyzed by a retina specialist in a store-and-forward telemedicine program over a 9-month time period (n = 833 eyes) and data was retrospectively reviewed. Image quality, degree of diabetic retinopathy and presence of macular edema were noted. Additional posterior segment pathologies were also documented. Differences in image quality following medical assistant retraining was also examined. Two-tailed Student's t-test was used for statistical analysis.
A total of 417 patients (n = 833 eyes) were included. Photos were graded as excellent (OD: 46.4%, OS: 43.6%), fair (OD: 30.4%, OS: 29.6%), poor (OD: 9.8%, OS: 11.8%), and ungradeable (OD: 13.4%, OS: 14.9%). The degree of retinopathy was classified as none (OD: 69.1%, OS: 68.7%), mild nonproliferative diabetic retinopathy (NPDR) (OD: 12.2%, OS: 9.4%), moderate NPDR (OD: 0.0%, OS: 0.24%), proliferative diabetic retinopathy (OD: 0.96%, OS: 0.48%), and unable to assess (OD: 17.7%, OS: 21.2%). The data were also stratified by date of acquisition, and quality of imaging before and after medical assistant retraining was assessed. The number of "poor" quality images decreased significantly (p=0.0005) subsequent to retraining. Twenty-one additional pathologies were also identified, including hypertensive retinopathy, optic nerve cupping and macular degeneration.
Screening imaging can serve as a useful tool in resource-poor and overburdened areas, including urban centers. A large majority of photos (85.5%) obtained by medical assistants were usable. Image quality improved after additional training. The technology can also be useful in identifying other ocular pathologies.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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