Abstract
Purpose :
The coronavirus-19 pandemic resulted in a significant backlog of patients requiring routine ophthalmic care including diabetic retinopathy (DR) screening. A retrospective, observational cohort study was performed to determine the results of a new virtual care program for patients overdue for DR assessment.
Methods :
Patients enrolled in Kaiser Permanente Southern California with a prior history of DR who were at least 1 year overdue for their regular diabetic eye exams were identified using level of service and diagnoses codes within the electronic medical record. Patients on waiting lists for traditional in-clinic evaluation were offered enrollment into this program to expediate their DR assessment. Visual acuity, intraocular pressure, ultrawide-field photographs, and macular optical coherence tomography scans were acquired by technicians at local eye care clinics and interpreted remotely by the Eye Monitoring Center under the supervision of a retina specialist. Patients with significant abnormalities were referred in for in-clinic evaluation and management. Patients without significant abnormalities continued in this program with re-evaluation every 6 months.
Results :
Seven hundred and ninety patients were enrolled: 54% of patients were Hispanic and 56% were male. The average age was 63.7 years (+/- 10.4 years). English and Spanish were the primary language for 71% and 29% of patients, respectively. Average hemoglobin A1c was 8.73 (+/- 2.16). There were 271 patients (34.3%) with a significant abnormality on initial evaluation: 18.9% had proliferative diabetic retinopathy, 9.1% had diabetic macular edema, 2% had evidence of glaucoma, 2% had poor retinal visualization due to a cataract, 1.5% had other macular diseases, 0.3% had retinal vein occlusions, 0.3% had peripheral retinal breaks, 0.1% had a retinal lesion, and 0.1% had an abnormal optic nerve.
Conclusions :
Over a third of patients overdue for DR evaluation had significant abnormalities on initial evaluation in this new program. This virtual care program represents a new model for achieving necessary ophthalmic assessment in patients with a prior history of DR, especially in vulnerable populations who may otherwise have difficulty being seen in regular clinic settings.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.