Evaluating Teleretinal Imaging Detection of Diabetic Retinopathy in the Dallas County Hospital System




Lee, Jessica

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INTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent diseases in the United States. Approximately one third of patients with diabetes have diabetic retinopathy, which is the leading cause of new cases of blindness among US adults ages 20-76 years. The American Academy of Ophthalmology recommends annual screenings for diabetic retinopathy beginning 5 years after the onset of DM1 and beginning promptly after diagnosis of DM2. Only 60% of people with DM have yearly screenings, which consist of a dilated eye exam. Nonmydriatic digital retinal imaging with remote image interpretation (teleretinal screening) is a promising new technology because it allows rapid retinal imaging without dilation of the pupil in primary care clinics, with the potential to reach more patients, detect disease earlier, facilitate compliance, and reduce barriers to specialized eye care. PURPOSE: To evaluate the effectiveness of a diabetic retinopathy teleretinal screening program and follow-up in a high-risk population. METHODS: Diabetic patients who had teleretinal imaging performed between April 1, 2013 and March 10, 2017 at the community-based primary care clinics of the Parkland Memorial Hospital system were identified through Epic electronic health records. Patient age, sex, screening date and interpretation, completed follow-up eye clinic appointments, and ocular diagnoses were recorded. RESULTS: 1155 patient charts were reviewed and of those, 399 (34.5%) underwent the screening and had a teleretinal image obtained. Of those screened, 279 (69.9%) were referred to optometry or ophthalmology clinic, and 114 (40.8%) were later seen in clinic. The most common reasons for referral were a yellow report without a specific interpretation (83.5%), mild or moderate non-proliferative diabetic retinopathy (6.8%), nerve-related disease (4.7%), and red report without a specific interpretation (2.2%). The percentage of agreement for all diagnoses was 76.3% and total sensitivity was 72.7%. Diabetic retinopathy was detected for the first time through teleretinal screening in 44 patients (11.0%). CONCLUSIONS: Teleretinal screening is a useful method for detecting diabetic retinopathy. However improvements need to be made in follow up of ordered screenings, image quality and interpretation, and referral follow-up.

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The 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)

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Lee, J., Nguyen, L., Lee, R., & Blomquist, P. (2018, January 23). Evaluating teleretinal imaging detection of diabetic retinopathy in the Dallas County Hospital System. Poster session presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/5349

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