Abstract
BackgroundTo describe implementation and first-year screening results of the first Chinese telehealth system for diabetic retinopathy (DR) - the Beixinjing Community Diabetic Retinopathy Telehealth system (BCDRT).MethodsBCDRT implementation was based on the acquisition of adequate digital retinographs, secure digital transmission, storage and retrieval of participants' data and reader-generated medical reports. Local diabetic residents meeting inclusion criteria were enrolled into the BCDRT system beginning in 2009. Participants recommended for further in-person examination with ophthalmologists were followed, and the consistencies in diagnoses between BCDRT and ophthalmologists for DR or macular edema were calculated.ResultsA total of 471 diabetic residents participated in BCDRT screening in 2009. The proportions of total DR, proliferative DR, and diabetic macular edema were 24.42% (115 patients), 2.12% (10 patients) and 6.47% (24 patients), respectively: 56 patients consulted ophthalmologists for further in-person retinal examination with funduscopy after pupil dilation. High rates of consistency between BCDRT screening and ophthalmologists were observed for macular edema (Kappa = 0.81), moderate or severe non-proliferative DR grade (Kappa = 0.92), and other DR grades (Kappa = 1). A total of 456 (96.82%) patients were willing to participate in the next BCDRT screening.ConclusionsBCDRT was a reliable and valid system for DR screening, and offers the potential to increase DR annual screening rates in local residents.
Highlights
To describe implementation and first-year screening results of the first Chinese telehealth system for diabetic retinopathy (DR) - the Beixinjing Community Diabetic Retinopathy Telehealth system (BCDRT)
In China, Early Treatment Diabetic Retinopathy Study (ETDRS) photography remains largely impractical for use in annual ophthalmic evaluations recommended for patients with diabetes, especially in primary care settings, because of several key disadvantages: requirements for skilled photographers and pupil dilation; the cost and inconvenience of film processing and archiving; the relatively long time spent on diagnosis
BCDRT is comprised of the Reading Center located in the Shanghai First People’s Hospital, the Peripheral Unit and the data server located in the Beixinjing community health service center
Summary
To describe implementation and first-year screening results of the first Chinese telehealth system for diabetic retinopathy (DR) - the Beixinjing Community Diabetic Retinopathy Telehealth system (BCDRT). In China, ETDRS photography remains largely impractical for use in annual ophthalmic evaluations recommended for patients with diabetes, especially in primary care settings, because of several key disadvantages: requirements for skilled photographers and pupil dilation; the cost and inconvenience of film processing and archiving; the relatively long time spent on diagnosis. As far as we know, the barriers to DR telemedicine system implementation in underdeveloped countries include relatively little knowledge about DR and poor follow-up compliance among the general diabetic population, poor ophthalmic infrastructure in primary care settings, and deficiency of wireless communication hardware and software to build specific local area networks for data transfer. In this report we present: (1) a detailed description of BCDRT development, (2) screening results of BCDRT in 2009, and (3) evidence that DR screening with BCDRT was as valid as traditional inperson screening
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