Implementation and first-year screening results of an ocular telehealth system for diabetic retinopathy in China

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.

Prevalence and Risk Factors of Idiopathic Epiretinal Membranes in Beixinjing Blocks, Shanghai, China

“…One possible reason may be ethnic differences, as mentioned by some previous studies [22], [24]. Interestingly, not just the prevalence of iERM but the prevalence of DR and age-related macular degeneration in our previous studies [39], [40] were lower than in Western countries. Another possible reason is different inclusion criteria for eligible participants.…”

Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

“…Referral rates from the screening programs ranged from 5.9% to 29%, depending on both the prevalence of STDR (5%–27.6%), as well as other criteria for referral. In particular, for two programs using fundus photograph screening, ungradable images made up 61.2% and 65% of referrals, respectively. Besides ungradable images, PDR, STDR and DME were the most common reasons for referral.…”

“…Common reasons for ungradable images included severe cataract, as well as corneal or vitreous opacities . Programs with lower rates of ungradable images had quality control mechanisms embedded in the image‐taking process, either automated or based on expertise of the photographer.…”

“…Common reasons for ungradable images included severe cataract, as well as corneal or vitreous opacities. 39,44 Programs with lower rates of ungradable images had quality control mechanisms embedded in the image-taking process, either automated or based on expertise of the photographer. For example, multiple studies suggested that NMC may need to be improved for non-Caucasian ethnic groups, perhaps because machines have not yet been trained on dark irises.…”

Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy

“…Different levels of care may include DR screening programmes of diabetic patients (Hautala 2013; Peto 2012), DR detection by optometrists and other non-medical eye care professionals in public or private eye care settings, and diagnosis and treatment in secondary or tertiary care by ophthalmologists or retinal specialists. Diabetic retinopathy screening by means of non-mydriatic fundus photography and telemedicine is now established in many countries (Andonegui 2012; Mansberger 2013; Peng 2011; Peto 2012; Vaziri 2013). The increasing availability and decreasing cost of OCT devices is making OCT attractive as a means of improving DMO detection within photographic telemedicine programmes, especially for reducing false positive referrals compared to fundus imaging alone (Adhi 2013; Mackenzie 2011; Olson 2013).…”