Abstract
Purpose :
The purpose of this study is to investigate patient follow-up with in-person eye care providers in the Diabetic Retinopathy Screening program at the University of Virginia. This study was also performed to identify the barriers to in-person follow-up care which is an essential component of an effective remote screening program.
Methods :
The University of Virginia (UVA) Department of Ophthalmology supplied fundus cameras to 17 primary care sites across Virginia to screen patients with diabetes for ocular disease. Images were obtained at the primary care site and were remotely graded by a single ophthalmologist at UVA. Patients with images that demonstrated any ocular pathology or who had images that were unable to be graded were recommended to follow up with an eye care provider. Patient screening data was recorded from sites that were actively screening patients between January 2021 to August 2023 including follow-up rates and insurance status.
Results :
Of the 8 sites that participated in this study, 438 patients underwent remote screening and 304 (69.4%) were recommended to follow-up with an eye care provider. Of the patients recommended to follow-up, 105 (34.5%) were referred for ocular pathology, 187 (61.5%) were referred due to poor image quality, and 12 (3.9%) fit both categories. In total, 100 (32.9%) completed the recommended in-person follow-up visit. Follow-up rates varied significantly across screening locations (14.3% - 100%). The average number of days to follow-up was 119.7 days. Of the patients recommended for follow-up, 80.2% had medical insurance. Overall, patients with insurance were more likely to receive follow-up than those without insurance (X2 (1, N = 183) = 6.3, p = .008). There was no association between gender and follow-up rates (X2 (1, N = 183) = 3.4, p = .066).
Conclusions :
After an abnormal remote eye screening at a primary care site, the follow-up rates with in-person eye care providers were overall suboptimal, demonstrating a disconnect between the process of tele-screening and the crucial step of connecting patients with the vision care they need. Placing remote fundus cameras at primary care sites significantly increases access to retinal screening in communities, but tangible initiatives must be implemented to ensure that patients receive in-person follow-up care with eye care providers to improve ocular care in these regions.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.