Abstract
Purpose :
Pacific Islanders face one of the highest rates of diabetes globally and are at increased risk of vision loss due to diabetic retinopathy. The purpose of this study was to pilot a low-cost, smart-phone based retinal screening system in Samoa, a population currently lacking access to subspecialty care with two full-time ophthalmologists serving an island nation of nearly 200,000 people. This approach aims to ameliorate current gaps in service delivery by enhancing the early detection of retinal disease.
Methods :
Our targeted, at-risk population included those aged 30.5 to 50 years with HbA1c ≥5.7%. Participants underwent free telemedicine eye screening which included non-mydriatic fundus photography using the PanOptic iExaminer System, medical history, and near visual acuity assessment between June to August 2018. Images were independently graded by an ophthalmologist and optometrist, who were blinded to patients’ demographic and biometric data.
Results :
A total of 3,421 images were obtained from 412 eyes of 206 patients using the portable fundus camera. 25.5% (105/412) of eyes had at least one image graded as excellent overall quality, 56.1% (231/412) as good, 11.4% (47/412) as fair, and 0.2% (1/419) as inadequate with no structures identifiable. A further 20 eyes (4.8%) were not successfully imaged by the device. Positive findings on telemedicine screening were identified in 29.1% of patients. Nonproliferative diabetic retinopathy was identified in 6 (2.9%) patients; no cases of proliferative diabetic retinopathy or diabetic macular edema were encountered. 32 (15.5%) patients had features suggestive of glaucoma (defined as a vertical cup-to-disc ratio ≥0.6 and/or asymmetry ≥0.2); 18 (8.7%) with hypertensive changes; and 10 (4.9%) with other lesions, tumors, or structural abnormalities. Nearly half (48.5%) of all patients were referred to a local ophthalmologist as a result of the screening program.
Conclusions :
Fundus images were consistently obtained using a portable, low-cost camera in an underserved diabetic population in Samoa. The relatively low prevalence of diabetic retinopathy identified in this segment of the Samoan population is likely due to the duration and severity of diabetes. Comparing these screening results with the outcomes of comprehensive eye examinations conducted by local Samoan ophthalmologists is needed to validate our findings with the PanOptic iExaminer System.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.