Abstract
BackgroundUsing telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.MethodsThis will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.ResultsSix-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.ConclusionsAlthough a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy and other ophthalmic conditions is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.
Highlights
Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care
The images were later accessed on a remote desktop computer where they were interpreted by a Temple University Hospital (TUH) board-certified optometrist or ophthalmologist with experience in the assessment of diabetic retinopathy from slit lamp biomicroscopy as well as digital fundus photography
Sixty-seven (9.7%) of 689 patients were suspected to have another ophthalmic condition based on other findings in the retinal photographs
Summary
Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. A multitude of factors have been suggested to contribute to this deficiency in modern diabetic eye care including, but not limited to, transportation barriers, financial burden, lack of education, and poor patient-physician communication and understanding [6]. This results in widespread lack of patient insight as demonstrated by a study from the 2005–2008 National Health and Nutrition Examination Survey which concluded that 73% of patients with DR were unaware of their condition [7]
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