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Susan Luo, Maxwell Wingelaar, Bohan Xing, Braden Burckhard, Yao Liu; Follow-up for in-person eye care after teleophthalmology diabetic eye screening in a U.S. academic medical center. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1132.
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Teleophthalmology provides evidence-based diabetic eye screening in primary care, but U.S. studies have reported low follow-up rates (e.g. 30%) for in-person eye care among screen positives. In this study, we evaluated follow-up outcomes after teleophthalmology in an academic U.S. medical center.
We retrospectively reviewed medical records of adults with diabetes who had teleophthalmology performed using a Topcon NW400 retinal camera (Topcon Medical Systems, Inc., Oakland, NJ, USA) at 2 primary care clinics in Madison, WI between Jan 2018 and Oct 2020. Single-field 45° images of the fundus and anterior photos of each eye were reviewed by eye care providers. Patients needing further in-person eye care were contacted by letter and by phone from schedulers to make an eye appointment. The primary outcome was chart documentation of a completed follow-up eye appointment within 1 year of imaging.
Among 361 patients, the average age was 58.4 years, 54% were men, and 98% had health insurance. 332 patients (92%) had gradable images, including 15% with diabetic retinopathy that was severe or worse in 0.6%. A total of 74 patients (21%) were referred for follow-up eye care due to either abnormal findings (13%) or ungradable images (8%). Patients referred for follow-up eye care were more likely to be insured by Medicare or Medicaid (p<0.001) than Commercial insurance. Pathologic findings were identified among 58% (n=19) of patients with ungradable images. No uninsured patients were referred for follow-up. There was a 65.5% follow-up rate (n=58) among patients imaged between Jan 2018 and Dec 2019, with 48.3% following up within the recommended timeframe. Patients with higher hemoglobin A1c (p=0.04) were less likely to follow-up. Among those that did not follow-up (n=20), 75% had made an eye appointment, but either cancelled (45%) or no-showed (30%). A total of 8 patients (21%) among those who followed up underwent treatment (e.g. laser, intravitreal injection, and/or cataract surgery).
We found higher follow-up rates (65.5%) for in-person eye care compared to prior reports. While lack of insurance has been cited as a major barrier, follow-up rates remain limited even among patients with insurance. Interventions to further increase follow-up are needed to more effectively improve visual outcomes after screening.
This is a 2021 ARVO Annual Meeting abstract.
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