Diabetic Retinopathy Screening: The First Telemedical Approach in an Italian Hospital

Abstract

The telemedicine approach provides a convenient, simple test that is well-received by patients and minimizes unnecessary referrals. Telemedicine may also reduce screening costs in our setting.

Diabetic Retinopathy in Italy: Epidemiology Data and Telemedicine Screening Programs

“…In Milano, a recent observational study reported a 1-year (2012-2013), single-center, remote evaluation of semiautomatic fundus photography for DR screening performed at the Endocrinology Unit, during routine systemic visits for patients with T2DM [40]. A total of 1281 adults with T2DM underwent fundus photos consisting in three 30-degree fields color fundus photos (central, nasal, and temporal) obtained before and after pupil dilation and thereafter assessed by 2 expert ophthalmologists who were blinded to the results of the slit-lamp fundus examination.…”

“…After pupil dilation 240 patients (18.74%) had ungradable images; approximately two thirds of patients (823 patients) did not have DR, and 218 (17.01%) were diagnosed with DR. Consequently, a total of 458 (35.75%) patients (240 ungradable and 218 with DR) were referred to the ophthalmologist. The authors evaluated also the economic impact of the telematic screening and reported a significant cost saving compared to slit-lamp fundus examination (the evaluated costs included reading centre staff evaluating images, fundus camera, and the cost of the standard funduscopic examination) [40]. …”

The Role of Telemedicine, In-Home Testing and Artificial Intelligence to Alleviate an Increasingly Burdened Healthcare System: Diabetic Retinopathy

“…There were also significant problems regarding telemedicine programs associated with a growing demand for trained/certified eye fundus photographers [ 81 ] and image readers [ 18 , 63 ]. As a solution to that problem, training in picture-taking could be offered to nurses and technicians [ 12 , 15 , 18 , 22 , 23 , 27 , 31 – 34 , 38 , 42 – 45 , 47 , 48 , 50 , 52 – 57 , 60 , 63 , 64 , 68 , 70 – 72 , 74 , 79 – 81 , 98 – 100 ]. One promising solution was in-home testing, where patients themselves took pictures of their retinas [ 97 ].…”

“…Better-educated patients preferred comprehensive eye examination to fundus camera screening test only [ 28 ], and some authors concluded that telemedicine should be targeted toward patients with poor access to medical care [ 23 , 120 ]. Non-ocular diseases and ocular diseases found incidentally by means of DR telescreening and AI included AMD, glaucoma, hypertensive retinopathy and disc pallor [ 21 , 28 , 34 , 38 , 45 , 49 , 50 , 55 , 64 , 75 , 81 ].…”

Telemedicine for screening diabetic retinopathy: The NO BLIND Italian multicenter study

“…However, in Italy, no national screening programme has been established yet. Only one report, in the north‐east of Italy, aimed to investigate incidence and prevalence of DR, through a tele‐retinal screening programme introduced in only two diabetes clinics of Padua in 2005, along with another telemedical approach in a single Italian hospital . Actually, a high estimate per year of screened patients, as well as the photo performed by only diabetologists, makes of the NO BLIND the first attempt in Italy to introduce a more definite screening programme for DR, also extendible to other geographical areas, and finally potentially validated on National Guidelines, as suggested by Diabetes Italian Society (SID) and Association of Diabetologists (AMD)…”