Diabetic Retinopathy Telemedicine Screening Could Greatly Benefit Underserved Populations

Jose Agustin Martinez, MD

New data shows that diabetic retinopathy (DR) screening via telemedicine can have long-term benefits for patients in underserved, urban areas.

A study presented at the American Society of Retina Specialists (ASRS) Annual Meeting in Vancouver, BC, this week gave support to burgeoning field of ophthalmologic telemedicine—a practice paradigm that could particularly change the standard for retinal exams and tests.

Researchers from the Dell Medical School at the University of Texas at Austin—led by Jose Agustin Martinez, MD—conducted a 2-year study to observe the use of primary care-based fundus cameras which uploaded retinopathy screenings for patients with diabetes to a local retina specialist. The study took place in an urban setting, at a primary care office established in a popular regional medical clinic that serves commercially-insured patient, from May 2015 through April 2017.

Through the fundus cameras, researchers collected data on the total number of patients screened, how many had DR, how many required further evaluation, and how many were actually evaluated by a trained retina specialists. They worked through a third party company to receive data through a cloud-based platform.

The fundus images sent to local retina specialists dictated whether at-risk patients would be scheduled for further analysis.

According to the study, 5764 patients received screening in the 2-year span. Among them, 5632 (97.7%) were found to have gradable images. Another 1830 (32.5%) were identified as having retinal pathology, and 1152 (20.5%) were diagnosed with DR.

Clinicians identified 668 as needing a retina examination appointment, of which 547 actually received—giving researchers a compliance capture rate of 81.9%. Among those examined, 82 (15%) received treatment.

In comparison to a pair of 2017 and 2016 JAMA Ophthalmology studies involving a rural, underserved population and urban, safety net population, respectively, which similarly tested for post-examination compliance capture rate among at-risk DR patients, the new data fared better. Just 60% and 29.9% of the 1681- and 949-patient populations reported compliance in the respective trials.

The 2017 study, similarly conducted in an underserved setting by researchers from the University of North Carolina (UNC) at Chapel Hill, found that 72.8% of its observed patients were either publicly insured or uninsured, and another 64.5% were racial/ethnic minorities.

Noting that minority patients were at greater odds of having advanced DR, the UNC-based researchers wrote that racial and ethnic differences commonly associate with low rates of diabetic eye examination—bolstering the need for telemedicine access.

“Reducing vision loss from DR is a public health imperative,” researchers wrote. “Telemedicine screening can increase rates of surveillance, reduce socioeconomic disparities, and increase access to care, ultimately preventing vision-threatening DR and improving visual outcomes and quality of life for patients with diabetes.”

These newest findings “confirm the utility of telemedicine” for DR screening, Martinez wrote—particularly in an insured, urban population. He and his colleagues also noted that the improved compliance capture lends to the notion that telemedicine-based DR screening has potential for expansion in the future.

The study, "Telemedicine for Diabetic Retinopathy Screening in an Urban, Insured Population Using Fundus Cameras in a Primary Care Office Setting," was presented at ASRS 2018.

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