Telemedicine and ocular health in diabetes mellitus

Abstract

Teleretinal/teleophthalmological programs that use existing health information technology infrastructure solutions for people with diabetes increase access to and adherence to appropriate eye care. Teleophthalmological studies indicate that the single act of patients viewing their own retinal images improves self-management behaviour and clinical outcomes. In some settings this can be done at lower cost and with improved visual outcomes compared with standard eye care. Cost-effective and sustainable teleretinal surveillance for detection of diabetic retinopathy requires a combination of an inexpensive portable device for taking low light-level retinal images without the use of pharmacological dilation of the pupil and a computer-assisted methodology for rapidly detecting and diagnosing diabetic retinopathy. A more holistic telehealth-care paradigm augmented with the use of health information technology, medical devices, mobile phone and mobile health applications and software applications to improve health-care co-ordination, self-care management and education can significantly impact a broad range of health outcomes, including prevention of diabetes-associated visual loss. This approach will require a collaborative, transformational, patient-centred health-care program that integrates data from medical record systems with remote monitoring of data and a longitudinal health record. This includes data associated with social media applications and personal mobile health technology and should support continuous interactions between the patient, health-care team and the patient's social environment. Taken together, this system will deliver contextually and temporally relevant decision support to patients to facilitate their well-being and to reduce the risk of diabetic complications.

Anti-vascular endothelial growth factor therapy for diabetic macular edema

“…In particular, recent screening data from the UK suggest that patients with established DR in both eyes may worsen at higher rates compared with other patients and may require particularly close follow up [Stratton et al 2012]. However, despite these guidelines, it is estimated that nearly 50% of patients with diabetes do not receive eye examinations on a regular basis [Bursell et al 2012].…”

“…Importance of screening, patient education, and compliance in the detection and management of diabetic retinopathy and diabetic macular edema DR is often asymptomatic until vision loss develops [Bragge et al 2011;Bursell et al 2012]. , 2012].…”

Impact of diabetic retinopathy

“…Because diabetic retinopathy is often asymptomatic until its later stages, early referral to an eye care provider is vital in preserving the vision of those patients [34,35]. Early detection of diabetic retinopathy requires prompt communication and collaboration between primary care physicians, endocrinologists, and ophthalmologists [36].…”

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

“…The entire process is supervised by a teleophthalmology coordinator. 9 The findings are reported to the primary care physician with the recommendation for referral. 24 Unreadable images are considered positive findings, and these patients must be referred for a comprehensive evaluation.…”