Diabetic retinopathy screening and the use of telemedicine

Zimmer-Galler, Ingrid; Kimura, Alan; Gupta, Sunil

doi:10.1097/icu.0000000000000142

Cited by 84 publications

(71 citation statements)

References 20 publications

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“…[23,24] We evaluated the quality of fundus photographs taken by an ophthalmic photographer with a non-mydriatic, handheld camera to investigate the factors affecting image quality, including patient characteristics and photographer experience over time. Not surprisingly, ocular media opacities (i.e., advanced cataract or vitreous hemorrhage) were associated with a decreased likelihood of obtaining a gradable retinal image.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

et al. 2017

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Purpose: To analyze predictors of image quality for a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy. Methods: An ophthalmic photographer at an Aravind Eye Hospital obtained nonmydriatic and mydriatic fundus images from 3 fields in 275 eyes of 155 participants over 13 months using a Smartscope camera (Optomed, Oulu, Finland) and a Topcon tabletop fundus camera (Topcon, Tokyo, Japan). Two fellowship-trained retina specialists graded the images. Repeated-measures logistic regression assessed predictors of the main outcome measure: gradability of the fundus images. Results: Of 2,475 images, 76.2% of the Smartscope nonmydriatic images, 90.1% of the Smartscope mydriatic images, and 92.0% of the Topcon mydriatic images were gradable. Eyes with vitreous hemorrhage (OR = 0.24, p < 0.0001) or advanced cataract (OR = 0.08, p < 0.0001) had decreased odds of image gradability. Excluding eyes with cataract or vitreous hemorrhage, nonmydriatic macular image gradability improved from 68.4% in the first set of 55 eyes to 94.6% in the final set of 55 eyes. Conclusion: With sufficient training, paraprofessional health care staff can obtain high-quality images with a portable nonmydriatic fundus camera, particularly in patients with clear lenses and clear ocular media.

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Section: Discussionmentioning

confidence: 99%

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

et al. 2017

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“…17–21 In digital imaging for both diabetic retinopathy and age-related macular degeneration, imaging protocols, grading algorithms, disease morphologies, and classification and staging of disease have been extensively examined and rigorously evaluated. The current reference standard for detecting, staging, and monitoring the progression of diabetic retinopathy is a protocol determined by the Early Treatment Diabetic Retinopathy Study that requires the use of a set of 7 different 30° retinal fields taken in stereo.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

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IMPORTANCEAs effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.OBJECTIVE To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013. DESIGN, SETTING, AND PARTICIPANTSA poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed. MAIN OUTCOMES AND MEASURESConsensus evaluation of discrepant image and examination findings for RW-ROP components. RESULTS Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G−/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E−). Among the sample of G−/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E− cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G−/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E− cases (95% CI, 67.3-72.8) for the presence of RW-ROP.CONCLUSIONS AND RELEVANCE This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.

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“…16,17 The Veterans Affairs program is the largest telemedicine diabetic retinopathy screening program in the United States. This program uses a “store and forward” technique to increase access to annual diabetic eye examinations.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…Coverage for telemedicine services among insurance providers varies, and the Current Procedural Terminology billing codes require clarification for applicability to telemedicine. 17 Individual state Medicaid programs have varying and individual restrictions and guidelines for telemedicine delivery. 40 Medicare only reimburses telemedicine services provided in rural areas and does not cover “store and forward” applications, except in Alaska and Hawaii.…”

Section: Barriers To Teleophthalmologymentioning

confidence: 99%

The Current State of Teleophthalmology in the United States

et al. 2017

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Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.

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Diabetic retinopathy screening and the use of telemedicine

Abstract: Telemedicine diabetic retinopathy screening programs may have a significant impact on reducing the vision complications and healthcare burden from the growing diabetes epidemic.

Cited by 84 publications

References 20 publications

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

The Current State of Teleophthalmology in the United States

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