Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes

Abstract

Abstract-We studied whether nonmydriatic digital retinal imaging with remote interpretation (teleretinal imaging) in the ambulatory care setting affected adherence to annual dilated eye examinations among patients with diabetes. We randomly assigned 448 patients to a teleretinal imaging group or a control group. We measured the number of patients who had dilated eye examinations within 12 months of group assignment and the agreement for level of diabetic retinopathy between teleretinal imaging and the eye examinations. The teleretinal imaging group (n = 223) had significantly more dilated eye examinations than the control group (n = 225). Teleretinal imaging and eye examination results showed significant correlation and moderate agreement. Cataract and smaller pupil size were significantly associated with ungradable retinal images. Two-thirds of patients with ungradable images had other ocular findings. Patients reported high satisfaction with nonmydriatic teleretinal imaging. Nonmydriatic teleretinal imaging improves diabetic retinopathy assessment rates.

Comparing the Effectiveness of Telemedicine and Traditional Surveillance in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial

“…The increase in diabetic retinopathy examinations was also found in three other randomized controlled trials in different populations. [34][35][36] Conlin et al 34 reported an increase in diabetic retinopathy screening examinations from 77% to 87% in a mostly white, male Veterans Affairs Hospital population in Boston, MA, whereas Davis and colleagues 35 reported an increase from 14% to 77% with telemedicine in a rural, largely African American community in South Carolina. Other nonrandomized observational studies have demonstrated a 50-250% increase in diabetic retinopathy screening examinations with telemedicine.…”

Framework for a national teleretinal imaging program to screen for diabetic retinopathy in Veterans Health Administration patients

“…Evidence from these pilot tests established the appropriateness of using teleretinal imaging technology [11,16]. In addition, other VISNs independently developed local and regional teleretinal imaging systems with similar technologies.…”

“…-Rationale: Limited evidence supports the assumption that teleretinal imaging improves patients' access to DR assessments [11]. While teleretinal imaging may increase the number of new cases of DR identified, the potential risk exists that other eye conditions (e.g., glaucoma) may not be detected if teleretinal imaging is applied in place of a comprehensive eye exam.…”

Eyes, economics and the environment: should green issues drive changes in ophthalmic care? – No

“…22 Telemedicine is under-used within ophthalmology, and could be used within eye casualty to reduce unnecessary hospital attendances generated from primary care or optometric practices. 23,24 A barrier to this is the vast inequality between technology available in optometric practice compared with the hospital eye service, which would need to be addressed to advance telemedicine and virtual consultations. However, cost saving measures such as virtual clinics through OCT reading centres must not be allowed to compromise the holistic care benefits of the doctor-patient relationship.…”