Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine

Abstract

Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.

Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images

“…Although most of the published works have been descriptive in nature, there have been some comparative trials that compared images from video fundus cameras to 35 mm film in detection of diabetic retinopathy. [7][8][9][10] The results so far have been encouraging. Relatively little work has been done on anterior segment telemedical examinations.…”

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics

“…The prevalence of diabetic retinopathy being diagnosed with nFP was similar to those reported by the Centers for Disease Control and Prevention recently, 1 but lower in both our study populations (rural and urban) compared with reports from several years ago. 3 Cummings et al 29 found the prevalence of diabetic retinopathy in a rural eastern North Carolina community to be as high as 40.9% among their study patients, much higher than our rural cohort. A similarly high incidence was reported by Murgatroyd et al 21 These observations may highlight possible regional differences among rural and urban communities even within the United States, or they may also highlight a possible recent trend toward a decrease in incidence of retinopathy with improved glycemic control.…”

Mosaics Versus Early Treatment Diabetic Retinopathy Seven Standard Fields for Evaluation of Diabetic Retinopathy Severity

“…Nonmydriatic 45°cameras have also been developed. Initially used in epidemiologic studies [7][8][9] and later in telemedicine applications, [10][11][12][13] nonmydriatic cameras are increasingly accepted in clinical practice. Attractive features include infrared illumination more comfortable to patients, special alignment guides, automatic focus, and programmable internal fixation target positions.…”