Marked reductions in visual impairment due to diabetic retinopathy achieved by efficient screening and timely treatment

Abstract

ABSTRACT.Purpose: Diabetic retinopathy (DR) is the most common complication of diabetes and needs to be diagnosed early to prevent severe sight-threatening retinopathy. Digital photography with telemedicine connections is a novel way to deliver cost-effective, accessible screening to remote areas. Screening for DR in a mobile eye examination unit (EyeMo) is compared to traditional service models (i.e. local municipal services or a commercial service provider). The quality of images, delays from screening to treatment, the stage of DR, coverage of screening and the rate of visual impairment due to DR are evaluated. Methods: EyeMo utilizes telemedicine technology. The electronic databases of the hospital and information from the Finnish Register of Visual Impairment were used to determine delays and the rate of visual impairment. Results: Fourteen thousand eight hundred and sixty-six fundus photographs were taken in EyeMo in 2007-2011. Coverage reached 78% of potential clients. No DR was detected in 43%, mild background retinopathy in 23%, moderate or severe background retinopathy in 31% and proliferative retinopathy in 3% of the evaluations. The quality of images was higher (p < 0.01) and delays shorter (p < 0.01) in EyeMo as compared to traditional service models. The rate of visual impairment due to DR decreased by 86% in the area covered by EyeMo, and the change compared favourably to the situation in the entire Finland (p < 0.0005). Conclusion: EyeMo is a feasible model of telemedicine application for screening of DR. Effective screening and timely access to care may indeed have influenced the reduced rate of visual damage.

Availability and variability in guidelines on diabetic retinopathy screening in Asian countries

“…Being highly sensitive and specific for detecting both early and referable DR, it has been shown to increase access to screening and proven to be cost-effective in community screening programmes 71–76. Recently, RP has also been increasingly applied in the field of teleophthalmology, especially in areas with limited resources and poor access to eye care, achieving significant reductions in DR-related visual impairment 18 77 78. In the event that RP is unavailable or images are unreadable, ophthalmoscopy can be used as an alternative for screening 79 80…”

The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future

“…32,33 A marked decrease in diabetic retinopathy related visual impairment can be achieved through screening and timely treatment. 34 However, the capacity of the health system to confront the disease should be considered before screening. A study conducted by Hashemi et al in rural areas in the north of Iran showed that diagnostic facilities did not improve in rural areas in the past decades and these areas even lacked minimum facilities and equipment for the treatment of ocular problems.…”

The Diabetic Retinopathy Screening Workflow

“…18 Similar screening workflows have been adopted in several other European nations also keen to reduce DR-related blindness. [9][10][11] In addition, automated screening algorithms have begun to be incorporated into the national DR screening program in Scotland, UK. 19 These offer the potential to screen out the bulk of healthy, and most time consuming to assess, images before a human retinal screener needs to be involved.…”