Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience

Ríos, Alicia; Bonaque-González, Sergio; Serrano-García, M.; Cabrera-López, Francisco; Abreu-Reyes, P.; Marrero-Saavedra, M.D.

doi:10.1016/j.oftale.2016.11.010

Cited by 16 publications

(24 citation statements)

References 24 publications

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“…Moreover, cases of severe NPDR and PDR constituted 14% initially and 3% at the end of the study. These findings underscore the fact that the full benefits of a DR screening program can take several years to develop [45].…”

Section: Telemedicine-based Screeningmentioning

confidence: 70%

“…Pareja-Ríos et al [45] reviewed 8 years of experience in teleophthalmology screening (Retisalud program; Canary Islands) and found that the number of patients screened per year increased steadily; the waiting times for image assessment decreased, and the ability of family doctors to correctly interpret retinographies improved progressively. In addition, the rate of ungradable retinographies decreased-partly owing to incorporation of mydriasis-and the percentage of images graded as normal increased [45]. Moreover, cases of severe NPDR and PDR constituted 14% initially and 3% at the end of the study.…”

Section: Telemedicine-based Screeningmentioning

confidence: 99%

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Fundamental principles of an effective diabetic retinopathy screening program

et al. 2020

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Background Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. Methods A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. Results The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Twofield retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. Conclusion Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.

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Section: Telemedicine-based Screeningmentioning

confidence: 70%

Section: Telemedicine-based Screeningmentioning

confidence: 99%

Fundamental principles of an effective diabetic retinopathy screening program

et al. 2020

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“…We identified 14 tele-ophthalmic services used for DR screening. 9–11,13,49–58 All used store-and-forward methods where a trained ocular technician, nurse or Indigenous health worker performed imaging on the patient using a non-mydriatic retinal camera. Additional information such as visual acuity and a medical history (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…60 In services employing a GP reader, the GP would often initially assess the images and refer only complicated cases to an ophthalmologist. 57 One such service reported that when first assessment of images was done by GPs 30% of cases were subsequently referred to an opthalmologist. 13 Australian trials show GPs are positive about including DR screening in their role.…”

Section: Resultsmentioning

confidence: 99%

Models of care in tele-ophthalmology: A scoping review

et al. 2017

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The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.

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“…The present study showed the efficiency of GPs in decreasing unnecessary referral cases in that they identified approximately 40% of cases as unnecessary for a referral. In a study by Rios, through primary evaluation by general practitioners between 55% to 68% of unnecessary referrals rate were decreased (29). In general, to manage this complication and to decrease the workload of specialists, primary evaluation by GPs and the referral of only abnormal cases to specialists are suggested.…”

Section: Discussionmentioning

confidence: 99%

Design, Development, and Evaluation of a Teleophthalmology System Using a Low-Cost Fundus Camera

Keshvardoost¹,

Bahaadinibeigy²,

Shadman³

et al. 2020

Acta Inform Med

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Introduction:The increasing prevalence of diabetic retinopathy in developing countries has become a worldwide concern. This problem is preventable by timely diagnosis and treatment; however, in the majority of cases, patients attend the eye clinics very late because of a lack of specialists and travel difficulties. Running a teleophthalmology system would significantly help to manage this disease. Aim: This study seeks to assess the accuracy of the teleophthalmology system and its effect on reducing unnecessary referrals in Iran. Methods: This study was conducted on 125 diabetic patients. First, the patients were examined by a retina specialist using a slit lamp and, then, single-field digital photos were captured by a portable, low-cost fundus camera. The images were uploaded onto a website and, after two months, were assessed by two retina specialists and two general practitioners (GPs). Finally, the diagnoses based on the digital photos were contrasted with the diagnoses established through face-to-face visits as a gold standard. Results:Out of 125 diabetic patients, eight (6.4%) were removed because of low-quality images and a total of 117 were evaluated. The sensitivity and specificity of each retina specialist presented with the photographs produced success rates of 90% and 97% respectively when judged against the gold standard of face-to-face visits. The rates of sensitivity for retinopathy referrals from the retina specialists were 92% and 85%. The sensitivity and specificity of their diagnoses of clinically significant macular edema (CSME) were calculated at 93% and 100%. The rates of sensitivity for each GP were 95% and 93% and the level of specificity was estimated to be approximately 98% for both GPs. The diagnosis rate for GPs when viewing the photographs as opposed to hosting face-to-face visits was more than 90%. Generally, with the implementation of this system, between 40% and 55% of referrals were calculated to have been avoidable. Conclusion: Our results from the first-ever research conducted on this topic in Iran showed that the teleophthalmology system is extremely accurate, that it can prevent unnecessary referrals and that it is useful for locating treatable patients. The results of this study could be of assistance in the running and expansion of such systems throughout Iran and Kerman Province to reduce eye damage arising from diabetes, decrease avoidable referrals to clinics, increase the availability of specialist visits for people in remote and rural areas and optimize the use of clinical infrastructures for patients in emergencies.

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Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience

Cited by 16 publications

References 24 publications

Fundamental principles of an effective diabetic retinopathy screening program

Fundamental principles of an effective diabetic retinopathy screening program

Models of care in tele-ophthalmology: A scoping review

Design, Development, and Evaluation of a Teleophthalmology System Using a Low-Cost Fundus Camera

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