The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application

Abstract

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

Fractal characterization of retinal microvascular network morphology during diabetic retinopathy progression

“…The application of non‐mydriatic fundus camera in combination with telemedicine for DR screening has been already evaluated and implemented at the local level in Italy with the plan for developing a national screening program. It has been shown to be a very effective and affordable tool for the prevention of blindness caused by DM . The application of the concept presented in our study at the primary care level could allow the inclusion of family physicians in the assessment of DR in all patients with DM at every visit regardless of the duration of the disease.…”

Diabetic Retinopathy in Italy: Epidemiology Data and Telemedicine Screening Programs

“…Another pilot screening program was recently performed (2012) in Ponzano, a part of the Local Health Authorities of Veneto Region, Treviso (northeast Italy), with participation of a multidisciplinary group including general practitioners, diabetes experts, administrative staff, nurses, epidemiologists and ophthalmologists, and the reading centre [39]. This project aimed to assess the feasibility of a future larger application, in comparison with the “no prevention” strategy.…”

“…Moreover, 9 cases required prompt treatment for either PDR or DME. Significant importance of screening program, also from an economic point of view, was found, leading to a substantial saving in comparison with the “no prevention” strategy, including the costs that avoid blindness, in terms of the validity of the intervention and the direct costs absorbed (efficiency) by the Regional Healthcare Service (Veneto Region) [39]. …”

Diabetic retinopathy screening programme utilising non‐mydriatic fundus imaging in slum populations of New Delhi, India

“…Epidemiologic studies on DR have utilised dilated retinal evaluation, using indirect ophthalmoscopy or by mydriatic four field or seven field fundus imaging by trained ophthalmologists [21][22][23][24][25]. Non-mydriatic fundus imaging has been utilised for screening in clinical settings [26][27][28][29][30]. However, the fundus cameras utilised in these settings (Canon CR5-45NM, Topcon TRC-NW6S) tend to be bulky, and not as easily transportable as anticipated [31][32][33].…”