Telemedicine for Long-term Surveillance of Diabetic Retinopathy
Diabetic retinopathy is the leading cause of blindness in the working population of the United States. The unequivocal recommendation for all diabetics is an annual retinal screening exam, according to the American Academy of Ophthalmology, the American Diabetes Association, retinal specialists and primary care physicians. Despite the earnest advice, just half of patients who need retinal exams follow through on the recommendation.
The use of telemedicine technology, such as IRIS – Intelligent Retinal Imaging Systems, has been shown to be effective for increasing the number of diabetics screened, allowing earlier diagnosis and treatment with greater preservation of vision and ability to continue working. The technology allows the capture of retinal images in a primary care setting, which are then transmitted to a remote retinal specialist or ophthalmologist, who can evaluate the images for retinopathy and macular edema.
In the United Kingdom, with its single payer system, identification of diabetics approaches 100 percent. With the use of telemedicine for annual retinal screening examinations in greater than 90 percent of the diabetic population, diabetic retinopathy is no longer the leading cause of blindness in the U.K.’s working-age population.
There is, however, minimal information regarding the long-term effectiveness of telemedicine to provide diabetic retinopathy screening, compared to traditional eye examination.
A multicenter, randomized, clinical trial was undertaken from August 1, 2006 through September 9, 2009. The 567 participants were randomized to either telemedicine with a nonmydriatic examination by camera in a primary care clinic (N=296), or traditional eye examination with an ophthalmologist (N=271).
Patients were followed for up to five years. After two years of a patient’s enrollment, telemedicine was offered to all participants.
The patients in the telemedicine group were more likely to receive diabetic retinopathy screening examination when compared with the traditional surveillance group. After telemedicine was offered to both groups, there was no difference between the groups in the percentages receiving retinal exams. The percent of telemedicine participants requiring referral to a retinal specialist or ophthalmologist ranged from 19.2 percent to 27.9 percent.
The researchers concluded that telemedicine increased the percentage of diabetic screening examinations, most participants did not require referral to an eye care professional, and diabetic retinopathy levels were generally stable during the study period. The findings indicate that telemedicine can be used in primary care clinics to screen for diabetic retinopathy and to monitor for advancing disease over a long period of time.
Mansberger SL, Sheppler c, et al. Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations. JAMA Ophthalmology. Published online March 5, 2015. Doi:10.1001.jamaophthalmol.2015.1
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