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Bryce Chiang, Jonathan Stevenson, Sunil Gupta, Yousuf Khalifa, April Maa; Tele-ophthalmology Screening Results: Differences in Disease Prevalence between Health Centers. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5236.
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Tele-ophthalmology, specifically diabetic teleretinal screening, has emerged as a cost-effective tool that improves screening rates and prevents blindness through early detection. While many studies have evaluated tele-ophthalmology in specific populations, very few studies have examined differences in disease rates across varying community settings. The purpose of this study was to investigate if there are differences in prevalence of diabetic and non-diabetic ocular diseases between underserved populations (aka, federally-qualified health centers or FQHCs) compared with non-FQHCs. We hypothesized that FQHCs would have increased burden of disease and greater disease severity than non-FQHCs.
All data was provided by Intelligent Retinal Imaging Systems (IRIS), a company that provides and supports end-to-end diabetic teleretinal screening program for multiple health care clinics and systems across the US. De-identified patient data from 9/1/2016-8/31/2017 was analyzed. Statistical analysis was performed with Graphpad Prism statistical software, and Chi-squared tests were used to compare samples as appropriate.
A total of 94,329 screening exams (39% seen at FQHCs), were performed in 150 cities throughout the US. The patients seen in FQHCs were significantly older (61 vs 55 years old, p<0.0001) and more likely to be female (60% vs 51% female, p<0.0001) compared with those seen in non-FQHCs. The percent of patients with any ocular pathology was 27% overall, 31% in FQHC, and 24% in non-FQHC (p<0.0001). Of patients seen in FQHCs, there were significantly increased prevalence of diabetic retinopathy (DR), diabetic macular edema (DME), suspected cataracts, and suspected glaucoma. Patients in FQHCs had significantly lower prevalence of suspected wet and dry age-related macular degeneration (AMD).
Patients cared for by FQHCs appear to have higher ocular disease burden than patients cared for by non-FQHCs. Possible causes for this include patient demographics (older population in FQHCs) and reduced resources to seek care (in FQHCs). Our data suggests FQHCs may require more resources not only in outreach and screening, but also to provide care for these patients. Furthermore, the data emphasizes how tele-ophthalmology deployed in the community can reduce health care disparities.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Percent of patients screened positive for disease, delineated by FQHC status. *** = p<0.0005.
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