Telemedicine Diagnoses More Diabetic Retinopathy

Implementing eye screening via telemedicine among patients with diabetes uncovered that 1 in 5 have diabetic retinopathy, according to a study published on November 13, 2014, in JAMA Ophthalmology.

Researchers from the University of Alabama at Birmingham (UAB) conducted a cross-sectional study at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic or racial minority populations and uninsured patients with diabetes. The 1894 participants in the Innovative Network for Sight (INSIGHT) study were aged 18 years or older and had either type 1 or 2 diabetes mellitus.

The participants were screened using a noninvasive nonmydriatic camera, which does not require dilation of the eye, and a telemedicine review.

Through that screening process, diabetic retinopathy was identified in at least 1 eye of approximately 1 in 5 patients (21.7%). Background diabetic retinopathy was the most common type, as it was present in 94.1% of those with the ocular disease. The researchers noted that 44.2% of patients screened had other findings, 30.7% of which were cataract.

“Among ethnic/racial minorities with diabetes, the rate of annual eye care is low, somewhere between one-third and one-half,” said lead study author Cynthia Owsley, PhD, a professor in the UAB Department of Ophthalmology, in a press release. “This study indicates that, if we can reach this population at local clinical facilities with an inexpensive screening process, we can diagnose diabetic retinopathy early when there is time to prevent or slow vision loss.”

Because the majority of ocular findings were background diabetic retinopathy, the authors pointed out that there is a high potential for intervention during the earliest phases of disease progression, which can prevent vision loss by monitoring glycemic control. They also emphasized that telemedicine screenings for diabetic retinopathy detected other ocular diseases for which screening programs may be underused.

“The rate of self-reported dilated eye care use in the past year was low for the overall sample—32.2%–suggesting that diabetic retinopathy screening in these settings could fulfill a critical role for patients with diabetes not routinely accessing annual dilated eye examination care,” the authors concluded.

Previous research has suggested that diabetic retinopathy screening programs are useful tools in lowering the rate of those with sight-threatening disease detected at subsequent screenings.

“This study suggests that telemedicine lends itself to screening and diagnosis of diabetic retinopathy,” Dr. Owsley summarized. “It is cost-effective and expands the reach of screenings by accessing regions that may be experiencing a shortage of ophthalmologists and optometrists.”