Abstract
Purpose :
With the increase in remote and tele-screenings for diabetic retinopathy over the last decade to improve quality care, it becomes imperative to assess the efficacy of such screening programs. We performed a retrospective review of non-mydriatic fundus photos read remotely as part of a pilot diabetic retinopathy screening program to assess the concordance of remote diagnoses as compared to in-office eye exams performed by eye care professionals.
Methods :
Forty-five-degree, non-mydriatic fundus photos of patients with diabetes were obtained between June 2022 and August 2023 at 13 internal medicine and endocrinology offices at a tertiary care, academic medical center. All photos were interpreted by optometrists and ophthalmologists, and patients were referred to ophthalmologists for in-office eye exams as needed. We evaluated the concordance of remote fundus photo interpretations and exam findings.
Results :
Over the 15-month period, 1402 patients underwent retinal imaging, 417 (29.7% of screened patients) were referred to see an ophthalmologist, and 212 (15.1% of screened patients) were seen within the affiliated academic medical center. Only 58 (4.1% of screened patients) were suspected to have diabetic retinopathy. Twelve of these patients (20.1%) were confirmed on in-office exam to have diabetic retinopathy severity within 1 stage of the remotely diagnosed retinopathy. Thirty-seven of all the screened patients were referred to ophthalmology for increased optic nerve cupping on remote evaluation. Twenty-nine of these patients (78.4%) were confirmed to be glaucoma suspects at subsequent in-person evaluations, and 12 patients (32.4%) were found to have retinal nerve fiber layer changes on baseline optical coherence tomography testing. Of the 72 patients referred due to poor quality fundus images, 51 patients (70.8%) were noted to have lenticular changes, and 1 patient (1.4%) was noted to have keratoconus on exam.
Conclusions :
While non-mydriatic fundus photos do not replace a dilated fundoscopic exam by a trained professional, they have the potential to facilitate recommended eye care. This preliminary data is being used to plan a prospective quality initiative to implement annual screening of all diabetic patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.