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Kristen Kuo, Sidrah Anjum, Shiyoung Roh, Jeffrey L. Marx, David J Ramsey; Effectiveness of Screening for Diabetic Retinopathy with Teleophthalmology in a Low-Risk Population. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1133.
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Early detection and treatment of diabetic retinopathy (DR) is important for preventing vision loss. We conducted a cross-sectional clinical study to assess the effectiveness of a teleophthalmology screening program that used non-mydriatic fundus photography (nFP) in a low-risk, well-insured suburban population of patients with diabetes.
214 patients due for annual diabetic eye screening with no prior history of DR were recruited to undergo nFP through their primary care providers at eight Beth Israel Lahey Health locations. Two 40° color fundus images centered on the disc and macula were obtained of both eyes and transmitted to a retinal specialist for remote review. The characteristics of these patients were compared to those of the total patient population eligible for nFP, as well as a 1:10 age-, sex-, and race-matched cohort. Income was estimated by the average household income based upon patients’ zip code. Patients in the teleophthalmology group who were diagnosed with DR through the program were compared with those who screened negative. Chi-square analyses and z-tests were performed for significance and odds ratios were computed for effect size.
The teleophthalmology program enrolled patients of lower income (p = 0.010) and with worse diabetes control as measured by HbA1c (7.39 ± 1.65 versus 7.05 ± 1.46, p = 0.004), when compared with the matched cohort. These patients were also less racially diverse, younger, and more likely to be male. Interestingly, these patients had lower blood pressures (<140/90 mmHg) and had had more recent eye exams, microalbumin tests, and HbA1c measurements than the matched cohort. A total of six patients (2.8%) were diagnosed with DR as a result of screening by nFP. This rate of new DR was within the expected range in such a low-risk population comprising mainly patients who had recently had a negative eye examination (χ2= 0.148, p = 0.701; χ2= 1.678, p = 0.195). Prior diabetic renal disease was predictive of new DR (OR 7.50 95% CI 1.25 – 44.82, p = 0.010).
The teleophthalmology program successfully reached a more medically-vulnerable patient population and found a rate of DR consistent with the expected rate of new DR in a low-risk population. Expanding nFP as a component of health maintenance outreach to patients from underserved cohorts will be potentially effective for proactively preventing complications from diabetes.
This is a 2021 ARVO Annual Meeting abstract.
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