Implementation and Pilot Data on Diabetic Retinopathy in a Teleophthalmology Program at a Multispecialty Primary Care Clinic
Joanne B. Tayapad, MD, Alfonso U. Bengzon, MD, Sherman O. Valero, MD, Milagros H. Arroyo, MD, Ricardo Tobias M. Papa, MD, Egidio Jose S. Fortuna, MD, Jocelyn G. Erni, BS, Myra Alisa J. Reyes, RN, Jerry D. Cavallerano, OD PhD, Lloyd Paul Aiello, MD PhD, Paolo S. Silva, MD
Objective:
To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.
Methods:
This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydriatic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.
Results:
Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% [110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).
Conclusion:
In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.
Keywords: Diabetic retinopathy, Diabetic retinopathy screening, Teleophthalmology, Retinal imaging, Telemedicine