Telehealth Practice Recommendations for Diabetic Retinopathy, Second Edition

Li, Helen K.; Horton, Mark B.; Bursell, Sven Erik; Cavallerano, Jerry D.; Zimmer-Galler, Ingrid; Tennant, Mathew; Abràmoff, Michael D.; Chaum, Edward; DeBuc, Delia Cabrera; Leonard-Martin, Tom; Winchester, Marc

doi:10.1089/tmj.2011.0075

Cited by 111 publications

(80 citation statements)

References 113 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Telemedicine with nonmydriatic cameras cannot detect all eye disease and, at this time, is not considered a replacement for a comprehensive eye examination. 18 Therefore, the clinics encouraged all participants to see an eye care provider once a year regardless of their group assignment for the study.…”

Section: Study Populationmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Study Populationmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…, or any level of DME) (12). Imagers were permitted to manipulate the color, brightness, contrast, gamma, or magnification of the images but did not view images stereoscopically.…”

Section: Methodsmentioning

confidence: 99%

Real-Time Ultrawide Field Image Evaluation of Retinopathy in a Diabetes Telemedicine Program

et al. 2015

View full text Add to dashboard Cite

OBJECTIVETo evaluate the ability of trained nonphysician retinal imagers to perform diabetic retinopathy (DR) evaluation at the time of ultrawide field retinal (UWF) imaging in a teleophthalmology program. RESEARCH DESIGN AND METHODSClinic patients with diabetes received Joslin Vision Network protocol retinal imaging as part of their standard medical care. Retinal imagers evaluated UWF images for referable DR at the time of image capture. Training of the imagers included 4 h of standardized didactic lectures and 12 h of guided image review. Real-time evaluations were compared with standard masked gradings performed at a centralized reading center. RESULTSA total of 3,978 eyes of 1,989 consecutive patients were imaged and evaluated. By reading center evaluation, 3,769 eyes (94.7%) were gradable for DR, 1,376 (36.5%) had DR, and 580 (15.3%) had referable DR. Compared with the reading center, real-time image evaluation had a sensitivity and specificity for identifying more than minimal DR of 0.95 (95% CI 0.94-0.97) and 0.84 (0.82-0.85), respectively, and 0.99 (0.97-1.00) and 0.76 (0.75-0.78), respectively, for detecting referable DR. Only three patients with referable DR were not identified by imager evaluation. CONCLUSIONSPoint-of-care evaluation of UWF images by nonphysician imagers following standardized acquisition and evaluation protocols within an established teleophthalmology program had good sensitivity and specificity for detection of DR and for identification of referable retinal disease. With immediate image evaluation, <0.1% of patients with referable DR would be missed, reading center image grading burden would be reduced by 60%, and patient feedback would be expedited.Patients with diabetes require lifelong ophthalmic care that generally includes an annual retinal evaluation (1). Given the rapidly growing population affected by diabetes, a 20-year estimate of .2.7 million eyes worldwide will need to be evaluated each day just to fulfill these needs (2). This enormous task is unlikely to be accomplished by the current approaches of diabetes eye care programs. Despite more than one decade of research, no real-time, fully automated retinal image analysis system is currently in active clinical use (2). Until such capability exists, other approaches to speed efficiency of current programs without sacrificing accuracy are urgently needed.

show abstract

“…24 Unreadable images are considered positive findings, and these patients must be referred for a comprehensive evaluation. 25 Our economic model was designed for the evaluation of a pharmacy-based teleophthalmology screening program, used to identify patients with no (or minimal) diabetic retinopathy and those with more than minimal diabetic retinopathy. 26 In this economic model, we considered the introduction of a part-time mobile retinal unit, operating 1 week per month on a rotational basis among regional pharmacies.…”

Section: Pharmacy-based Teleophthalmology Programmentioning

confidence: 99%

“…27 Similarly, patients with unclear fundus photographs would be referred for in-person examination by a retina specialist. 25 …”

Section: Pharmacy-based Teleophthalmology Programmentioning

confidence: 99%

Diabetic retinopathy screening with pharmacy-based teleophthalmology in a semiurban setting: a cost-effectiveness analysis

et al. 2016

View full text Add to dashboard Cite

CMAJ OPEN, 4(1) E95D iabetic retinopathy is a sight-threatening complication in patients with diabetes mellitus that is usually asymptomatic in the early stages. 1 Effective treatment exists, with over 50% of patients experiencing reduction of severe vision loss if they receive treatment after timely diagnosis. 2About 50% of patients with diabetes do not receive eye examinations as recommended by the American Academy of Ophthalmology.3 This results in lost opportunities to prevent severe vision loss by means of timely treatment delivery. 4 In addition to nonmodifiable factors, limited availability of eye care specialists, travelling difficulties and time constraints also contribute to nonadherence, especially in nonurban areas. 5,6 Pharmacy-based teleophthalmology has emerged as a possible alternative to in-person examinations that may facilitate compliance with evidence-based recommendations and reduce barriers to specialized eye care. 7,8 In a pharmacy-based teleophthalmology program, retinal digital images are captured in a local pharmacy and are securely transmitted electronically to a specialized reading centre, where photographs are graded by an eye specialist.9 Patients with signs of diabetic retinopathy can then be referred to an eye care professional Background: Diabetic eye complications are the leading cause of visual loss among working-aged people. Pharmacy-based teleophthalmology has emerged as a possible alternative to in-person examination that may facilitate compliance with evidence-based recommendations and reduce barriers to specialized eye care. The objective of this study was to estimate the cost-effectiveness of mobile teleophthalmology screening compared with in-person examination (primary care) for the diabetic population residing in semiurban areas of southwestern Ontario.

show abstract

Telehealth Practice Recommendations for Diabetic Retinopathy, Second Edition

Cited by 111 publications

References 113 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

Real-Time Ultrawide Field Image Evaluation of Retinopathy in a Diabetes Telemedicine Program

Diabetic retinopathy screening with pharmacy-based teleophthalmology in a semiurban setting: a cost-effectiveness analysis

Contact Info

Product

Resources

About