Abstract
Purpose :
Teleophthalmology improves diabetic eye screening and eye care access, but only if patients with diabetic retinopathy (DR) follow up in person in a timely manner. We explored demographic, socioeconomic, and clinical factors that may impact eye care follow-up after remote DR screening at an integrated health system in California.
Methods :
We conducted a retrospective review of patients who underwent teleretinal screening for DR at the University of California, Davis Health System between 2018-2022. Retinal images were captured using undilated fundus cameras, and graded by trained ophthalmologists or optometrists. We collected patient demographics (age, sex), socioeconomic data (language, income), and clinical history (glycemic control, comorbidities, and retinopathy findings) from patient medical records. Multivariate regressions were used to determine the association of these factors with (1) any follow-up within 1 year, (2) follow-up within the recommended time frame, and (3) time to follow-up.
Results :
Among 1553 patients (mean age 61 years old, 47% female) who underwent remote DR screening, 490 (32%) received a recommendation for in-person ophthalmic care, including non-urgent (30%, <3 months) and urgent (2%, <1 month) referrals. Only 151 (32%) referrals were attended, and 89 (19%) were completed within the recommended time frame. Retired individuals (OR 1.69, p=0.011) and those with macular pathology (OR 1.29, p=0.007) were more likely to attend their referrals. Patients with systemic comorbidities (OR 0.13, p=0.023) or non-English or -Spanish speakers (OR 0.08, p=0.021) were less likely to follow up within the recommended time frame. Both patients with comorbidities (mean difference=57.9 days, p=0.0037) and non-English or -Spanish speakers (mean difference=59.6, p=0.005) took around 2 months longer to complete their follow-up. There is a trend wherein individuals with higher income are more likely to follow up within the recommended time frame (B estimate= 0.00001, p=0.082). Neither follow-up attendance nor time to follow-up were associated with age, sex, race, or ethnicity.
Conclusions :
Fewer than half of patients referred to an eye care provider after teleretinal DR screening actually followed up in person, with only 19% attending their referral within the recommended time frame. Non-English or Spanish speakers, or those with systemic comorbidities are less likely to follow up in a timely manner.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.