June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
CCHS Diabetic Retinopathy Screening Project: A Retrospective Review.
Author Affiliations & Notes
  • Lindsay Gugerty
    Christiana Care Health Services Inc, Wilmington, Delaware, United States
    Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States
  • Paula Ko
    Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Constance Cox-Wong
    Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Jeffrey D Henderer
    Temple University Health System Inc, Philadelphia, Pennsylvania, United States
    Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Footnotes
    Commercial Relationships   Lindsay Gugerty None; Paula Ko None; Constance Cox-Wong None; Jeffrey Henderer None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3785 – F0206. doi:
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      Lindsay Gugerty, Paula Ko, Constance Cox-Wong, Jeffrey D Henderer; CCHS Diabetic Retinopathy Screening Project: A Retrospective Review.. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3785 – F0206.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Non-mydriatic digital retinal imaging can improve patient access to diabetic retinal screening exams. We performed a retrospective review to determine if digital retinal imaging could be utilized in the Christiana Care Health System (CCHS) primary care setting to identify pathology and assist those needing follow-up. This technology could be crucial in maintaining patients' health in a cost-effective way.

Methods : Diabetic patients aged 18 years and older who participated in the Intelligent Retinal Imaging System (IRIS, Pensacola, FL) retinal screening initiative at four primary care clinics in the Christiana Care Health System (Wilmington, DE) from September 2018 to November 2020 were included. Photos were taken by clinic staff using the Volk Pictor Plus Fundus camera. Retinal images were interpreted by CCHS-affiliated ophthalmologists using a modified ICDR system and the results communicated to the primary care clinic via IRIS. IRIS data and the electronic medical record (EMR) was utilized to record the screening result and follow-up recommendations. Outcomes of interest included number of interpretable images, the pathology identified, documentation of referral, and number of patients who completed a follow-up exam.

Results : 613 patients (1226 eyes) underwent the screening exam but there was no documentation of an exam result in the EMR for 50 (8.1%) patients. Of the 411 patients (73%) who had bilateral interpretable images, 323 (78.6%) of patients had no pathology in either eye. 88 patients had a referrable diagnosis which included 53 with diabetic retinopathy ((60.2%) (35 mild, 12 moderate, 2 severe, 4 proliferative), and a mixture of other suspected diseases. For the 238 patients (42.3%) uninterpretable or diseased patients for whom follow-up was recommended, 165 patients (69.3%) had referrals generated by the primary care physician. Of these, 65 (39.4% and 27.3% of the original 238) had a follow-up exam with an optometrist or ophthalmologist documented in the EMR.

Conclusions : Utilizing the IRIS protocol, the majority of patients were able to complete a diabetic screening. However, taking quality photographs remains a limitation. The majority of patients who needed a follow-up referral received one, yet a minority of patients followed through with the exam. We have found several areas to improve: importing IRIS exams into the EMR, generating referrals, and patient follow-up. Our next step is to address these issues.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.


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