Retinal diseases in a reference center from a Western Amazon capital city

Malerbi, Fernando Korn; Matsudo, Nilson Hideo; Carneiro, Adriano Guedes; Lottenberg, Claudio Luiz

doi:10.1590/s1679-45082015ao3538

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Of note is the previous lack of experience of the trained team, as previous reports have presented high-quality rates obtained with experienced personnel [1,15,16]. The sustainability and cost-effectiveness of screening programs are also fundamental for its implementation and success; to the best of our knowledge, ours is the first report on the performance of low-cost, portable handheld devices for DR screening in an urban setting in Brazil, a continent-sized country with very heterogeneous socioeconomic realities and an uneven distribution of ophthalmologists [17], home to the fifth biggest diabetic population in the world [18] and also to the largest public free and chronically underfinanced healthcare system [19]. Multiple socioeconomic barriers prevent access to eye examination in the poor regions of Brazil [3].…”

Section: Discussionmentioning

confidence: 68%

“…Multiple socioeconomic barriers prevent access to eye examination in the poor regions of Brazil [3]. Recently, several authors have proposed teleophthalmology to increase access in Brazil and elsewhere, with favorable cost-effectiveness results and a reduced burden to specialized services [3,16,17], in both geographically isolated [15] and highly urbanized areas [20].…”

Section: Discussionmentioning

confidence: 99%

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Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Queiroz

Carvalho²,

Bortoto

et al. 2020

Acta Diabetol

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Aims To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. Methods This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. Results A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. Conclusions A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Queiroz

Carvalho²,

Bortoto

et al. 2020

Acta Diabetol

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“…Adequate image quality is a major factor on which the success of the screening strategy is dependent upon [12], and we hereby present favorable results and a high rate of clinical yield attained after a brief training and subsequent continuous remote feedback; of note is the previous lack of experience of the trained team. The sustainability and costeffectiveness of screening programs are also fundamental for its implementation and success; to the best of our knowledge, ours is the rst report on the performance of low-cost, portable hand-held devices for DR screening in a urban setting in Brazil, a continent-sized country with very heterogeneous socioeconomic realities and an uneven distribution of ophthalmologists [13], home to the fth biggest diabetic population in the world [14] and also to the largest public free and chronically under nanced healthcare system [15]. Multiple socioeconomic barriers prevent access to eye examination in the poor regions of Brazil [2].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple socioeconomic barriers prevent access to eye examination in the poor regions of Brazil [2]. Recently, several authors have proposed teleophthalmology to increase access, with favorable cost-effectiveness results and a reduced burden to specialized services [13,16].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy Screening in Urban Primary Care Setting with a Handheld Smartphone-based Retinal Camera.

Queiroz

Carvalho²,

Bortoto

et al. 2020

Preprint

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Aims: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary health care setting; to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience on retinal imaging. Methods: Prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according need of referral. Results: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years-old, diabetes duration 10.7 ± 8.2 years and A1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher A1c was associated with referable DR. Conclusion: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of Covid-19 pandemic.

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“…Both modes are effective for detecting modifications in the retina and optic nerve, and CFP can be integrated to telemedicine protocols, a combination that offers a good cost-effective profile, 4 - 7 besides allowing expanded access to diagnosis when there is an imbalance between offer and demand for specialists. 8 , 9 Currently, in the Brazilian public health system, there are no precise guidelines as to the type of retinal examination that should be requested.…”

Section: Introductionmentioning

confidence: 99%

Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation

Malerbi

Carneiro

Katz

et al. 2019

Einstein (São Paulo)

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Objective: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than-3.00 diopters. Results: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.

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Retinal diseases in a reference center from a Western Amazon capital city

Cited by 5 publications

References 15 publications

Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Diabetic Retinopathy Screening in Urban Primary Care Setting with a Handheld Smartphone-based Retinal Camera.

Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation

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