Screening for diabetic retinopathy: the first telemedical approach in a primary care setting in France

Massin, Pascale; Aubert, JP; Erginay, Ali; Jc, Bourovitch; Ben-Mehidi, A; Audran, Ghislaine; Bernit, Blandine; Jamet, M; Collet, Corinne; Laloi-Michelin, M.; Pj, Guillausseau; Gaudric, Alain; Marre, Michel

doi:10.1016/s1262-3636(07)70142-8

Cited by 49 publications

(29 citation statements)

References 18 publications

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“…36,37 Similar to previous studies we used ''moderate diabetic retinopathy'' or worse, ''macular edema,'' and ''unable to determine'' as the criteria for further evaluation, which resulted in approximately 21% of participants requiring referral in the telemedicine group. 26,27 If we ignore ''unable to determine'' and use only ''severe diabetic retinopathy or worse,'' our proportion of referral (2%) would be similar to a previous study with 4.4%. 38 However, we used ''unable to determine'' as the criteria for referral because most telemedicine protocols would recommend referral if the eye was unable to be examined with photographs.…”

Section: Discussionsupporting

confidence: 51%

“…38 However, we used ''unable to determine'' as the criteria for referral because most telemedicine protocols would recommend referral if the eye was unable to be examined with photographs. 26,27 Poor-quality images were the most common reason (86% of referrals) for referral in our study. Poor-quality nonmydriatic imaging may occur because of small pupil size or ocular media abnormalities (e.g., cataract) because these conditions decrease illumination of the retina.…”

Section: Discussionmentioning

confidence: 59%

“…26,27 We used a Fisher's exact test to compare the stage of diabetic retinopathy between the groups. To determine the burden of referral from inadequate examinations in the telemedicine group, we compared the demographic characteristics of those with a grade of ''unable to determine'' for diabetic retinopathy or macular edema with the same parameters of those who had gradable images to determine whether there were demographic factors associated with not being able to obtain a diabetic retinopathy screening examination with telemedicine.…”

Section: Discussionmentioning

confidence: 99%

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

Mansberger

Gleitsmann

Gardiner

et al. 2013

Telemedicine and e-Health

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The protocol of this study is registered as ''The Comparative Effectiveness of Telemedicine to Detect Diabetic Retinopathy'' with ClinicalTrials.gov having clinical trial registration number NCT01364129. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The sponsor or funding organization had no role in the design or conduct of this research. AbstractObjective: To determine the effectiveness of telemedicine for providing diabetic retinopathy screening examinations compared with the effectiveness of traditional surveillance in community health clinics with a high proportion of minorities, including American Indian/Alaska Natives. Subjects and Methods: We conducted a multicenter, randomized controlled trial and assigned diabetic participants to one of two groups: (1) telemedicine with a nonmydriatic camera or (2) traditional surveillance with an eye care provider. For those receiving telemedicine, the criteria for requiring follow-up with an eye care provider were (1) moderate nonproliferative diabetic retinopathy or higher, (2) presence of clinically significant macular edema, or (3) ''unable to grade'' result for diabetic retinopathy or macular edema. Results: The telemedicine group (n = 296) was more likely to receive a diabetic retinopathy screening examination within the first year of enrollment compared with the traditional surveillance group (n = 271) (94% versus 56%, p < 0.001). The overall prevalence of diabetic retinopathy at baseline was 21.4%, and macular edema was present in 1.4% of participants. In the telemedicine group, 20.5% would require further evaluation with an eye care provider, and 86% of these referrals were because of poorquality digital images. Conclusions: Telemedicine using nonmydriatic cameras increased the proportion of participants who obtained diabetic retinopathy screening examinations, and most did not require follow-up with an eye care provider. Telemedicine may be a more effective way to screen patients for diabetic retinopathy and to triage further evaluation with an eye care provider. Methods to decrease poor quality imaging would improve the effectiveness of telemedicine for diabetic retinopathy screening examinations.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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

Mansberger

Gleitsmann

Gardiner

et al. 2013

Telemedicine and e-Health

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“…In a pilot study in 109 volunteers conducted in China as the first teleophthalmology health system for screening and diagnosis of diabetic retinopathy and also for evaluation and review of the present system, items such as trained people's qualification, hardware required for taking images, image analysis software, and digital data storage, retrieval, and transmission system were evaluated and finally approved [38].…”

Section: Discussionmentioning

confidence: 99%

Development of a store-and-forward telescreening system of diabetic retinopathy: lessons learned from Iran

Sedaghat

Langarizadeh

Ramezani

et al. 2018

J Diabetes Metab Disord

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Background The present study describes the development and identity phases of a teleophthalmology system used for screening of diabetic retinopathy. Methods A questionnaire was used to identify the main factors necessary for diagnosis of diabetic retinopathy and the features required for a teleophthalmology system. In the second phase, a web-based prototype of the system was designed using the data collected in the previous phase. In the final phase, the system was optimized based on the users' ideas and comments; then, it was evaluated through a standard usability testing questionnaire.Results The results showed that the lowest average percentages were related to ethnicity (61%), optometrist's office address (61%), and consultant physician's office address (65%). A web-based prototype was designed using the Visual Studio and Dreamweaver programming tools. This system comprised patient identity data, medical history, clinical data, and retinal images of the patient. The mean score of usability testing and user satisfaction including specialists, residents, and optometrist was 7.3, 7.1 and 7.3 (out of a total 9), respectively. The evaluation results revealed that the system was classified as good. Conclusion The telescreening system suggested in the current study could be helpful in timely diagnosis. Moreover, it would reduce the treatment costs and complexities. Regardless of the positive points of telemedicine systems, one of the most challenges in this study was the Internet infrastructure to design and apply the system. The future studies, therefore, could focus on the application of cell phone technology for rendering teleophthalmology.

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“…7 Other than diabetic retinopathy, nonmydriatic cameras can detect eye disease of the optic disc, macula, and peripheral retina. [8][9][10][11] This report is a part of a multicenter randomized clinical trial comparing the effectiveness of telemedicine using nonmydriatic cameras to traditional care with eye care providers. We hypothesized that different eye diseases, including diabetic retinopathy, may be detectable and common, especially given that diabetes is a potential risk factor for other eye diseases such as glaucoma 12 and vascular occlusions.…”

mentioning

confidence: 99%

Eye Disease in Patients with Diabetes Screened with Telemedicine

Park

Mansberger

2017

Telemedicine and e-Health

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The protocol of this study is registered as ''The Comparative Effectiveness of Telemedicine to Detect Diabetic Retinopathy'' with ClinicalTrials.gov having clinical trial registration number NCT01364129. AbstractBackground: Telemedicine with nonmydriatic cameras can detect not only diabetic retinopathy but also other eye disease. Objective: To determine the prevalence of eye diseases detected by telemedicine in a population with a high prevalence of minority and American Indian/Alaskan Native (AI/AN) ethnicities. Subjects and Methods: We recruited diabetic patients 18 years and older and used telemedicine with nonmydriatic cameras to detect eye disease. Two trained readers graded the images for diabetic retinopathy, age-related macular degeneration (ARMD), glaucomatous features, macular edema, and other eye disease using a standard protocol. We included both eyes for analysis and excluded images that were too poor to grade. Results: We included 820 eyes from 424 patients with 72.3% nonwhite ethnicity and 50.3% AI/AN heritage. While 283/424 (66.7%) patients had normal eye images, 120/424 (28.3%) had one disease identified; 15/424 (3.5%) had two diseases; and 6/424 (1.4%) had three diseases in one or both eyes. After diabetic retinopathy (104/424, 24.5%), the most common eye diseases were glaucomatous features (44/424, 10.4%) and dry ARMD (24/424, 5.7%). Seventeen percent (72/424, 17.0%) showed eye disease other than diabetic retinopathy. Conclusions: Telemedicine with nonmydriatic cameras detected diabetic retinopathy, as well as other visually significant eye disease. This suggests that a diabetic retinopathy screening program needs to detect and report other eye disease, including glaucoma and macular disease.

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Screening for diabetic retinopathy: the first telemedical approach in a primary care setting in France

Cited by 49 publications

References 18 publications

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

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

Development of a store-and-forward telescreening system of diabetic retinopathy: lessons learned from Iran

Eye Disease in Patients with Diabetes Screened with Telemedicine

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