Abstract
Purpose :
Early detection of diabetic retinopathy (DR) and glaucoma is crucial to preventing vision loss. Previous studies have evaluated teleretinal screening programs for DR in well-insured populations. The purpose of this retrospective, observational study was to evaluate a teleretinal screening program in a population of uninsured and underinsured patients.
Methods :
We conducted a retrospective chart review of patients (age≥18) who underwent teleretinal imaging (TRI) at a federally qualified health center between January 1, 2015 and September 4, 2019. TRI gradings, patient demographic information, relevant medical history, laboratory data, and information from subsequent ophthalmology visits were abstracted. Generalized estimating equations were used to identify factors associated with ophthalmology referral and adherence to ophthalmology referral.
Results :
3130 TRI were graded in 2216 eyes from 1108 patients. Only 47.4% (N=184) of the 388 patients referred for a dilated fundus examination based on TRI followed up with ophthalmology as recommended. Adherence to the recommended ophthalmology exam was not associated with any of the baseline clinical or demographic characteristics (p>0.10). Referral to ophthalmology based on TRI gradings was associated with a greater likelihood of also having diabetic nephropathy, diabetic neuropathy, hypertension, proteinuria, GFR<60, older age, and higher hemoglobin A1c (all p<0.05). Female (odds ratio [OR], 0.75; p=0.001) and Hispanic patients (OR, 0.79; p=0.009) were less likely to receive an ophthalmology referral compared with male and non-Hispanic patients respectively. In a multivariable model, older age, male sex, proteinuria, and A1c remained significantly associated with a greater likelihood of ophthalmology referral (all p<0.05). There was high agreement between TRI gradings for glaucoma or DR and final diagnoses for patients who underwent subsequent ophthalmology examination (88.9% and 92.1% respectively).
Conclusions :
In this study of uninsured/underinsured patients, those referred to ophthalmology based on TRI were more likely to have other complications of diabetes. However, fewer than 50% of patients attended the recommended follow-up examination. Improved care coordination is critical to ensure patients adhere to follow-up recommendation for a dilated fundus examination following teleretinal screening.
This is a 2021 ARVO Annual Meeting abstract.