Abstract
Purpose :
Diabetic retinopathy (DR) is a common cause of vision loss among patients with diabetes mellitus, and early diagnosis can reduce the risk of vision loss. In this study, we investigate if remote retinal imaging enables earlier eye care access in patients with newly diagnosed diabetes mellitus in the United States over the past decade.
Methods :
We identified patients with newly-diagnosed type II diabetes and at least 1 year and up to 5 years of continuous enrollment between 2011-2020 using the OptumLabs® Data Warehouse (OLDW) – a longitudinal, real-world dataset with de-identified administrative claims and electronic health record data for commercial insurance and Medicare Advantage enrollees in the U.S.. We compared the time from initial diagnosis to the first eye exam by 1) teleretinal screening, defined by Current Procedural Terminology codes for remote retinal imaging (92227 or 92228) or fundus photography (92250) by non-eye care providers, or by 2) in-person eye exam, defined as any encounter with an eye care provider.
Results :
We identified 968 846 patients with newly diagnosed type II diabetes who were continuously enrolled for at least 1 year. At year 1, 5 459 (0.6%) patients underwent remote eye imaging and 208 023 (27%) underwent an in-person DR screening. The median time (95% confidence interval) to screening was 2.0 (0-10.9) months for remote imaging and 3.4 (0-11.0) months for in-person visits. Interestingly, 27.5% of remote screenings were performed on the same day of diabetes diagnosis. Excluding same-day screenings, median time to screening was 4.1 months (0.2-11.3) for remote eye imaging and 4.3 months (0.3-11.1) for in-person exams. After year 1, the proportion of eyes that underwent remote imaging remained stable at 0.75% in year 2 and 0.7% in year 5, while the proportion that underwent in-person eye care visits increased slowly to 32.1% and 43.5% at years 2 and 5, respectively.
Conclusions :
Teleophthalmology using remote retinal imaging enabled earlier access to eye care among patients newly diagnosed with diabetes, primarily by enabling same-day ophthalmic screening at the time of initial diagnosis. More widespread use of teleretinal screening may enable earlier diagnosis of diabetic retinopathy and prevent vision loss.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.