Identification of diabetic retinopathy using a telehealth eye screening program in South Louisiana and the Mississippi Gulf Coast Region

Abstract

Purpose : South Louisiana and the Mississippi Gulf Coast region have among the highest diabetes mellitus (DM) rates in the US, with many not receiving regular eye exams, and the number with undiagnosed diabetic retinopathy (DR) is unknown. We retrospectively analyzed the results of our patient-centric telehealth diabetic eye screening program at Ochsner Health which identified new cases of DR and its sub-stages over a 5-year period in South Louisiana and Mississippi Gulf Coast region.

Methods : All patients in the Ochsner Health system with DM without a previous of history of DR and lacked timely eye exams to meet HEDIS standards were eligible for a non-mydriatic fundus camera DR screening encounter. We included all 11428 patients screened between Jan 1, 2018, through Dec 1, 2023. Ochsner-affiliated eye physicians graded fundus images as: 1) Ungradable, 2) No DR, 3) Mild non-proliferative diabetic retinopathy (NPDR), 4) moderate NPDR, 5) severe NPDR, or 6) proliferative diabetic retinopathy (PDR). All data and diagnoses were stored and tracked via our Epic EMR Eye Screening dashboard. Percentages of DR and its subtypes were calculated for each year, and we created a linear regression model for overall trend of new cases of DR.

Results : We identified 1343 patients, representing 11.75% of the study cohort, with newly diagnosed DR including the occurrence of 822 patients with mild NPDR, 416 with moderate NPDR, 58 with severe NPDR, and 47 with PDR. The ungradable rate trended downward from 21% in 2018 to 16% by 2023. The percentage of new cases of DR decreased each year from 15.4% (395/2565) in 2018 down to 9.3% (156/1682) in 2023, demonstrating a statistically significant linear regression curve (R²=0.85, p<0.01). The percentage of each DR stage per year was: Mild 62±5.3% (mean ± SD), moderate 29±7.0%, severe 4.8±2.6%, and PDR 3.6±1.7%. Overall, 33-45% of new cases of DR demonstrated worse than mild retinopathy and 5-11% were severe NPDR or PDR.

Conclusions : Our telehealth DR screening program highlights that while the identification of new cases of DR are decreasing, there is a substantial number of patients with undiagnosed DR and importantly, those with unrecognized vision-threatening DR in South Louisiana and Mississippi Gulf Coast region. These results demonstrate the importance of providing DR screening opportunities using a patient centric approach.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.