Abstract
Purpose :
Populations of low- and middle-income countries (LMICs) have poorer access to eye care due to fewer ophthalmologists per capita. Telemedicine enables remote diabetic retinopathy screening and widely improves access. This study aims to evaluate the current role of telemedicine for diabetic retinopathy screening in LMICs.
Methods :
A systematic search of PubMed, Embase, Web of Science, and Cochrane Central was undertaken. Studies were included if they involved the use of telemedicine, as defined by the American Association of Telemedicine (ATA), for diabetic retinopathy screening among populations in LMICs. The outcomes reflected the quality of telemedicine according to ATA categories, screening personnel, location, and system used.
Results :
Of 301 studies retrieved, 38 were included, involving a total of 206,725 individuals, and comprising 34 cross-sectional studies, 3 randomised controlled trials, and 1 cohort study. The publication year ranged from 2007-2021. The studies were from Bangladesh, Brazil, Cameroon, China, Costa Rica, India, Iran, Kenya, Lebanon, Mexico, Nepal, Peru, Zambia, and Zimbabwe. ATA Category 2 and 3 clinical validation for screening were attained in 61% (n = 23) and 18% (n = 7) of the studies, with the remaining 21% (n = 8) being ATA Category 1. The majority of studies (n = 20) appointed either technicians or nurses as image acquisition personnel, while image graders largely involved ophthalmologists (n = 35). The most common location of screening were hospitals (n = 18), followed by health centres (n = 11), mobile clinics (n = 10), and primary care clinics (n = 9). A median of 2 pictures (range = 1-7) were taken in each study, the majority being non-stereo (n = 31). Nineteen studies used non-mydriatic imaging, 14 utilised mydriasis, and 4 performed dilation as needed. Whilst 55% (n = 21) of the studies involved opportunistic screening programmes, 45% (n = 17) were systematic screening programmes integrated within the healthcare system, and 71% (n = 27) comprised follow-up pathways.
Conclusions :
A variety of telemedicine tools have been attempted in LMICs and have successfully screened a large number of individuals. However, more funding and infrastructure are needed for these programmes to be integrated into the healthcare system for systematic population-level screening.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.