Abstract
Purpose :
Telemedicine expands eye care access and improves screening rates for diabetic retinopathy (DR). Here, we evaluate the role of geography on teleophthalmology utilization and follow-up by measuring average driving distance and time of patients who underwent remote DR screening at an integrated health system in Northern California.
Methods :
We conducted a retrospective study of adult patients with diabetes who underwent teleretinal screening at the University of California, Davis Health system from July 2018 to December 2022. We employed ArcGIS to calculate the estimated driving distance and time from home to the primary care clinic in which teleretinal screening was conducted, and compared it to the nearest eye care provider within the same health system. We collected demographic data such as age, sex, and race/ethnicity, as well as clinical data such as HbA1c, medical or diabetic co-morbidities, and follow-up rates. Statistical analyses were performed using paired t-tests, as well as logistic and multiple linear regressions.
Results :
Among 1498 patients with diabetes (mean age 61.4 years) who underwent teleretinal screening, age and sex were not associated with driving distance or time, while Asians (p<0.001), Blacks (p=0.01), and other races (p<0.001) lived an average of 3.7, 2.7, and 3.3 miles closer respectively to a screening clinic than Whites. Mean (SD) driving distance was 11.4 (12.3) miles to the teleretinal screening site, and 10.7 (10.9) miles to the nearest UC Davis eye provider (p<0.001). Mean (SD) driving time was 17.3 (13.3) minutes to screening site, and 17.0 (11.9) minutes to the nearest eye center (p=0.09). The likelihood of a patient attending a follow-up eye provider appointment when retinal pathology was identified was not impacted by driving distance (p = 0.63) or time (p=0.46).
Conclusions :
While geographic disparities exist for eye care access, the availability of a teleophthalmology program improved DR screening rates, despite similar driving distance and time to the teleretinal screening site and an in-person eye provider. Thus, telemedicine may offer benefits beyond overcoming geographic barriers.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.