Telescreening Programs Could Help Identify the Rates of Retinal Pathology

Matthew Ohr, MD

Despite being frequently referred by primary care physicians and other providers for dilated fundus examination in diabetic patients, many patients fail to complete their eye exams.

However, a potential solution to this problem is telescreening programs, which have been shown to improve compliance.

In findings presented at the American Society of Retina Specialists 2020 (ASRS 2020) Virtual Sessions, a team, led by Matthew Ohr, MD, Director of the Retina Division, The Ohio State University, evaluated the rates of retinal pathology identified during a diabetic retinal telescreening program in a high risk population.

The investigators examined the medical records of all patients who underwent Diabetic Telescreening retinal imaging at The Ohio State University Wexner Medical Center between May 7, 2019 and August 12, 2019. They imaged and evaluated 200 eyes from 100 patients, 64 of which were females.

A total of 98 patients suffered from type 2 diabetes mellitus and 2 patients suffered from type 1 diabetes mellitus. The mean age was 56.

During the study period, the imaging was deployed at 2 different sites, selected based on a high risk patient population identified as having many patients of lower socioeconomic status and higher rates of disease. Patients at these sites had the lowest compliance for recommended diabetic eye exams and all imaging was performed on an ultrawide field camera (UWF).

The non-mydriatic imaging was performed by medical assistants in the primary care office and read by a retinal specialist.

The investigators graded 196 eyes with images high quality enough to be graded and 68 patients had identifiable pathology.

In addition, 85 of the 200 eyes were found to have no diabetic retinopathy, 88 had mild nonproliferative diabetic retinopathy (NPDR), 11 were noted to have moderate NPDR, and 6 had severe NPDR.

The investigators also found 1 patient had an undiagnosed high risk proliferative diabetic retinopathy, 5 eyes had quiescent PDR, 4 eyes were unreadable, 8 eyes had clinically significant diabetic macular edema, and 36 patients were referred to an ophthalmologist for further evaluation.

“With minimal training, non-ophthalmic medical assistants can be trained to capture high quality non-mydriatic ultra-wide field fundus photos for diabetic screening,” the authors wrote. “In high risk populations, the rates of retinal pathology are significantly higher. Diabetic telescreening is an effective strategy to identify patients that need intervention and reduces the barriers associated with noncompliance.”

Earlier this year, the results of a National Institutes of Health (NIH)-sponsored study found an ophthalmic condition linked to blindness in diabetics could serve as an additional indicator of increased stroke risk.

Analysis of more than 2500 patients revealed patients who had diabetic retinopathy were at an increased risk of stroke compared to nondiabetics and was associated 60% higher risk of stroke when comparing diabetics without and without the ophthalmic condition.

The study, “Diabetic Retinal Telescreening Program in a High-Risk Population Highlights Significant Rates of Retinal Pathology,” was published online by ASRS 2020.