Abstract
Purpose :
Investigate and report on the utility of implementing a telemedicine model using an ultra-widefield camera for the screening of diabetic retinopathy (DR).
Methods :
The Optos Daytona ultra-widefield device was set up at the University of North Carolina (UNC) Internal Medicine Clinic along with OptosAdvance for retinal specialists at the UNC Kittner Eye Center to read images. Patients at the internal medicine clinic with type II diabetes who were due for annual diabetic retinal screening were identified and given the option to undergo screening with the ultra-widefield camera. Imaging was completed by trained care assistants and medical students. Following image acquisition, images were sent over a HIPAA-compliant web interface to a retinal specialist who could then interpret the images and send a diagnosis and management report back to the patient and their primary care physician. Statistical analysis was completed using SPSS 26, and distances were recorded as the direct distance from UNC Kittner Eye Center. The OptosAdvance ETDRS 7-standard field mask was placed over images to help delineate peripheral findings.
Results :
A total of 625 patients (1,247 eyes) with type II diabetes underwent ultra-widefield (UWF) fundus imaging between May 2019 and November 2019. The study population consisted of 333 females (54.95%) and 273 males (45.05%) with a mean age of 62 years. Twelve patients were excluded from analysis due to poor image quality or inability to capture, resulting in a 1.94% failure rate. The study model added an average of 4 minutes and 44.7 seconds to the overall visit, expanded the coverage of DR screening by a linear diameter of 6 miles, and increased the UNC Internal Medicine clinic’s diabetic retinopathy screening compliance rate from 53.0% to 72.8%. Amongst the 113 patients found with DR, 28.07% were considered new patients to UNC Ophthalmology. Compared to simulated ETDRS image capture, 50.9% of patients with DR were found to have additional peripheral findings.
Conclusions :
Telemedicine, in conjunction with the ultra-widefield device, increased the coverage of diabetic screening, increased the referral base, improved clinic compliance of screenings, and mildly increased visit times. The ultra-widefield camera showed to provide additional information for the clinician for the majority of images with pathology and with a low failure rate.
This is a 2020 ARVO Annual Meeting abstract.