Eye Disease in Patients with Diabetes Screened with Telemedicine

Abstract

The protocol of this study is registered as ''The Comparative Effectiveness of Telemedicine to Detect Diabetic Retinopathy'' with ClinicalTrials.gov having clinical trial registration number NCT01364129. AbstractBackground: Telemedicine with nonmydriatic cameras can detect not only diabetic retinopathy but also other eye disease. Objective: To determine the prevalence of eye diseases detected by telemedicine in a population with a high prevalence of minority and American Indian/Alaskan Native (AI/AN) ethnicities. Subjects and Methods: We recruited diabetic patients 18 years and older and used telemedicine with nonmydriatic cameras to detect eye disease. Two trained readers graded the images for diabetic retinopathy, age-related macular degeneration (ARMD), glaucomatous features, macular edema, and other eye disease using a standard protocol. We included both eyes for analysis and excluded images that were too poor to grade. Results: We included 820 eyes from 424 patients with 72.3% nonwhite ethnicity and 50.3% AI/AN heritage. While 283/424 (66.7%) patients had normal eye images, 120/424 (28.3%) had one disease identified; 15/424 (3.5%) had two diseases; and 6/424 (1.4%) had three diseases in one or both eyes. After diabetic retinopathy (104/424, 24.5%), the most common eye diseases were glaucomatous features (44/424, 10.4%) and dry ARMD (24/424, 5.7%). Seventeen percent (72/424, 17.0%) showed eye disease other than diabetic retinopathy. Conclusions: Telemedicine with nonmydriatic cameras detected diabetic retinopathy, as well as other visually significant eye disease. This suggests that a diabetic retinopathy screening program needs to detect and report other eye disease, including glaucoma and macular disease.

Telemedicine for Glaucoma: Guidelines and Recommendations

“…25 A number of teleretinal programs have published high rates of incidental detection of glaucomatous-appearing optic nerves, and suspected glaucoma is a major contributor to clinical referrals in teleretinal diabetic screening. 26,27…”

Use of Expectation Disconfirmation Theory to Test Patient Satisfaction with Asynchronous Telemedicine for Diabetic Retinopathy Detection

“…Therefore, the American Diabetes Association, the American Academy of Ophthalmology, and other scientific organizations recommend regular or annual screenings for diabetic retinopathy; however, a significant proportion of people with diabetes do not undergo such examinations [ 4 , 5 ]. Prior studies show that patient satisfaction is critical in improving patients' decisions to seek appropriate healthcare [ 6 , 7 ] and this extends to diabetic retinopathy exams [ 8 ]. In fact, recent work suggests that telemedicine shows promise for diabetic retinopathy screening, with the potential to increase patient adherence with prescribed disease management practices (e.g., blood sugar control, office visits, and medication compliance), all of which can help prevent end-organ damage [ 7 ].…”

Detection of idiopathic intracranial hypertension, enabled by tele-ophthalmology

“…15,16 This is in line with publications from Canada and the United Kingdom, which highlight how comprehensive tele-ophthalmology can be a useful tool in the screening of multiple ocular diseases other than diabetic retinopathy as well. 6,17 Our case adds an additional example to the literature of how comprehensive tele-ophthalmology can improve access, thereby bringing patients to medical attention at an earlier stage of disease. Furthermore, it supports the expansion of comprehensive teleophthalmology programs by offering a glimpse into its utility for patients with atypical presentations.…”