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Podnar B, Albreht T, Cvenkel B. Relative Importance of Glaucoma-Referral Indicators in Retinal Images in a Diabetic Retinopathy Screening Programme in Slovenia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1441. [PMID: 37629731 PMCID: PMC10456555 DOI: 10.3390/medicina59081441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Glaucoma is a major cause of irreversible visual impairment and blindness, so its timely detection is crucial. Retinal images from diabetic retinopathy screening programmes (DRSP) provide an opportunity to detect undiagnosed glaucoma. Our aim was to find out which retinal image indicators are most suitable for referring DRSP patients for glaucoma assessment and to determine the glaucoma detection potential of Slovenian DRSP. Materials and Methods: We reviewed retinal images of patients from the DRSP at the University Medical Centre Ljubljana (November 2019-January 2020, May-August 2020). Patients with at least one indicator and some randomly selected patients without indicators were invited for an eye examination. Suspect glaucoma and glaucoma patients were considered accurately referred. Logistic regression (LOGIT) with patients as statistical units and generalised estimating equation with logistic regression (GEE) with eyes as statistical units were used to determine the referral accuracy of indicators. Results: Of the 2230 patients reviewed, 209 patients (10.1%) had at least one indicator on a retinal image of either one eye or both eyes. A total of 149 (129 with at least one indicator and 20 without) attended the eye exam. Seventy-nine (53.0%) were glaucoma negative, 54 (36.2%) suspect glaucoma, and 16 (10.7%) glaucoma positive. Seven glaucoma patients were newly detected. Neuroretinal rim notch predicted glaucoma in all cases. The cup-to-disc ratio was the most important indicator for accurate referral (odds ratio 7.59 (95% CI 3.98-14.47; p < 0.001) and remained statistically significant multivariably. Family history of glaucoma also showed an impact (odds ratio 3.06 (95% CI 1.02-9.19; p = 0.046) but remained statistically significant only in the LOGIT multivariable model. Other indicators and confounders were not statistically significant in the multivariable models. Conclusions: Our results suggest that the neuroretinal rim notch and cup-to-disc ratio are the most important for accurate glaucoma referral from retinal images in DRSP. Approximately half of the glaucoma cases in DRSPs may be undiagnosed.
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Affiliation(s)
- Barbara Podnar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tit Albreht
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- National Institute of Public Health, 1000 Ljubljana, Slovenia
| | - Barbara Cvenkel
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Mobile Telemedicine Screening for Diabetic Retinopathy Using Nonmydriatic Fundus Photographs in Burgundy: 11 Years of Results. J Clin Med 2022; 11:jcm11051318. [PMID: 35268409 PMCID: PMC8911379 DOI: 10.3390/jcm11051318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
We analyzed the results of mobile screening for diabetic retinopathy (DR) using retinal photographs, comparing these results between rural and periurban areas, and before and after the first national COVID-19 pandemic lockdown. The Burgundy Union Régionale des Professionnels de Santé (URPS) has organized an annual DR screening since 2004. The examination, performed by an orthoptist, consisted of taking the patient's history, intraocular pressure measurement, and taking retinal photographs. After remote transmission, the examinations were interpreted by participating ophthalmologists at the Dijon University Hospital. In September 2016, the screening was open to periurban townships. In 11 years, 10,220 patients were screened: 1,420 patients (13.9%) had DR of any type, with an average age of 68.5 (±11.3) years, and 59.2% were men. These patients had a statistically significantly higher glycated hemoglobin level (7.4% vs. 7.0%) and a longer duration of diabetes (13.8 vs. 9.3 years) than patients without DR. When comparing rural and periurban areas and periods before and after the beginning of the COVID-19 pandemic, we did not find any significant difference in the screening results. The results of this study are in line with the average findings of similar studies comparing screening strategies for DR. The early detection of DR can benefit from mobile telemedicine screening, identifying a considerable number of patients at an elevated risk, especially in rural areas where access to ophthalmological care is limited.
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Kanclerz P, Tuuminen R, Khoramnia R. Imaging Modalities Employed in Diabetic Retinopathy Screening: A Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11101802. [PMID: 34679501 PMCID: PMC8535170 DOI: 10.3390/diagnostics11101802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Urbanization has caused dramatic changes in lifestyle, and these rapid transitions have led to an increased risk of noncommunicable diseases, such as type 2 diabetes. In terms of cost-effectiveness, screening for diabetic retinopathy is a critical aspect in diabetes management. The aim of this study was to review the imaging modalities employed for retinal examination in diabetic retinopathy screening. METHODS The PubMed and Web of Science databases were the main sources used to investigate the medical literature. An extensive search was performed to identify relevant articles concerning "imaging", "diabetic retinopathy" and "screening" up to 1 June 2021. Imaging techniques were divided into the following: (i) mydriatic fundus photography, (ii) non-mydriatic fundus photography, (iii) smartphone-based imaging, and (iv) ultrawide-field imaging. A meta-analysis was performed to analyze the performance and technical failure rate of each method. RESULTS The technical failure rates for mydriatic and non-mydriatic digital fundus photography, smartphone-based and ultrawide-field imaging were 3.4% (95% CI: 2.3-4.6%), 12.1% (95% CI: 5.4-18.7%), 5.3% (95% CI: 1.5-9.0%) and 2.2% (95% CI: 0.3-4.0%), respectively. The rate was significantly different between all analyzed techniques (p < 0.001), and the overall failure rate was 6.6% (4.9-8.3%; I2 = 97.2%). The publication bias factor for smartphone-based imaging was significantly higher than for mydriatic digital fundus photography and non-mydriatic digital fundus photography (b = -8.61, b = -2.59 and b = -7.03, respectively; p < 0.001). Ultrawide-field imaging studies were excluded from the final sensitivity/specificity analysis, as the total number of patients included was too small. CONCLUSIONS Regardless of the type of the device used, retinal photographs should be taken on eyes with dilated pupils, unless contraindicated, as this setting decreases the rate of ungradable images. Smartphone-based and ultrawide-field imaging may become potential alternative methods for optimized DR screening; however, there is not yet enough evidence for these techniques to displace mydriatic fundus photography.
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Affiliation(s)
- Piotr Kanclerz
- Hygeia Clinic, 80-286 Gdańsk, Poland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Correspondence: ; Tel./Fax: +48-58-776-4046
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Eye Centre, Kymenlaakso Central Hospital, 48100 Kotka, Finland
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany;
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Zamorano LS, Calero Magaña P, García Cisneros E, Martínez AV, Martín LF. Cocoa olein glycerolysis with lipase Candida antarctica in a solvent free system. GRASAS Y ACEITES 2020. [DOI: 10.3989/gya.0794191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper we present the valorization of cocoa olein obtained from the acid fat-splitting of soapstocks. The aim is to develop a solvent free process (enzymatically catalyzed) to maximize the production of a final product with high content of monoglycerides (MAG) and diglycerides (DAG). The effect of the enzyme dose, glycerol content, reaction times as well as the modification of the raw material and pressure were studied. The yield of the reaction increased up to 90-95% when using a vacuum of 2-3 mbar at 65 °C, enough to evaporate the water which is generated as a by-product, an enzyme dose of 1% and molar ratio oil:glycerol of 1:2. The highest yield in terms of MAG and DAG production was obtained by starting from a raw material which was rich in free acidity (FFA), rendering oil with 33.4 and 44.2% MAG and DAG, respectively. Short reaction times (6-8 h) were observed compared to previously reported results (24 h).
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Boureau AS, Masse H, Chapelet G, de Decker L, Chevalet P, Pichierri S, Weber M, Berrut G. Tele-ophthalmology for screening for eye diseases in older patients with cognitive complaints. J Telemed Telecare 2020; 27:493-500. [PMID: 31896286 DOI: 10.1177/1357633x19893883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. METHODS This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. RESULTS The mean age of the 298 patients included was 83.5 years ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. DISCUSSION The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.
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Affiliation(s)
- Anne-Sophie Boureau
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France.,L'Institut du Thorax, Université de Nantes, France
| | - Helene Masse
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | | | - Laure de Decker
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Pascal Chevalet
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Sophie Pichierri
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Michel Weber
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | - Gilles Berrut
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
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Keshvardoost S, Bahaadinibeigy K, Shadman H, Tafreshi AG, Baneshi MR. Design, Development, and Evaluation of a Teleophthalmology System Using a Low-Cost Fundus Camera. Acta Inform Med 2020; 28:12-17. [PMID: 32210509 PMCID: PMC7085307 DOI: 10.5455/aim.2019.28.12-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The increasing prevalence of diabetic retinopathy in developing countries has become a worldwide concern. This problem is preventable by timely diagnosis and treatment; however, in the majority of cases, patients attend the eye clinics very late because of a lack of specialists and travel difficulties. Running a teleophthalmology system would significantly help to manage this disease. Aim: This study seeks to assess the accuracy of the teleophthalmology system and its effect on reducing unnecessary referrals in Iran. Methods: This study was conducted on 125 diabetic patients. First, the patients were examined by a retina specialist using a slit lamp and, then, single-field digital photos were captured by a portable, low-cost fundus camera. The images were uploaded onto a website and, after two months, were assessed by two retina specialists and two general practitioners (GPs). Finally, the diagnoses based on the digital photos were contrasted with the diagnoses established through face-to-face visits as a gold standard. Results: Out of 125 diabetic patients, eight (6.4%) were removed because of low-quality images and a total of 117 were evaluated. The sensitivity and specificity of each retina specialist presented with the photographs produced success rates of 90% and 97% respectively when judged against the gold standard of face-to-face visits. The rates of sensitivity for retinopathy referrals from the retina specialists were 92% and 85%. The sensitivity and specificity of their diagnoses of clinically significant macular edema (CSME) were calculated at 93% and 100%. The rates of sensitivity for each GP were 95% and 93% and the level of specificity was estimated to be approximately 98% for both GPs. The diagnosis rate for GPs when viewing the photographs as opposed to hosting face-to-face visits was more than 90%. Generally, with the implementation of this system, between 40% and 55% of referrals were calculated to have been avoidable. Conclusion: Our results from the first-ever research conducted on this topic in Iran showed that the teleophthalmology system is extremely accurate, that it can prevent unnecessary referrals and that it is useful for locating treatable patients. The results of this study could be of assistance in the running and expansion of such systems throughout Iran and Kerman Province to reduce eye damage arising from diabetes, decrease avoidable referrals to clinics, increase the availability of specialist visits for people in remote and rural areas and optimize the use of clinical infrastructures for patients in emergencies.
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Affiliation(s)
- Sareh Keshvardoost
- Medical Informatics Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinibeigy
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Mohammad Reza Baneshi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Safdari R, Langarizadeh M, Ramezani A, Khodaveisi T, Nejad AF. Development of a store-and-forward telescreening system of diabetic retinopathy: lessons learned from Iran. J Diabetes Metab Disord 2018; 17:31-36. [PMID: 30288383 PMCID: PMC6154520 DOI: 10.1007/s40200-018-0335-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/31/2018] [Indexed: 11/16/2022]
Abstract
Background The present study describes the development and identity phases of a teleophthalmology system used for screening of diabetic retinopathy. Methods A questionnaire was used to identify the main factors necessary for diagnosis of diabetic retinopathy and the features required for a teleophthalmology system. In the second phase, a web-based prototype of the system was designed using the data collected in the previous phase. In the final phase, the system was optimized based on the users’ ideas and comments; then, it was evaluated through a standard usability testing questionnaire. Results The results showed that the lowest average percentages were related to ethnicity (61%), optometrist’s office address (61%), and consultant physician’s office address (65%). A web-based prototype was designed using the Visual Studio and Dreamweaver programming tools. This system comprised patient identity data, medical history, clinical data, and retinal images of the patient. The mean score of usability testing and user satisfaction including specialists, residents, and optometrist was 7.3, 7.1 and 7.3 (out of a total 9), respectively. The evaluation results revealed that the system was classified as good. Conclusion The telescreening system suggested in the current study could be helpful in timely diagnosis. Moreover, it would reduce the treatment costs and complexities. Regardless of the positive points of telemedicine systems, one of the most challenges in this study was the Internet infrastructure to design and apply the system. The future studies, therefore, could focus on the application of cell phone technology for rendering teleophthalmology.
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Affiliation(s)
- Reza Safdari
- 1Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- 2Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- 3School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taleb Khodaveisi
- 2Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Barsegian A, Kotlyar B, Lee J, Salifu MO, McFarlane SI. Diabetic Retinopathy: Focus on Minority Populations. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2017; 3:034-45. [PMID: 29756128 PMCID: PMC5945200 DOI: 10.17352/ijcem.000027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Diabetic retinopathy is a major cause of blindness in the United States. With rise of the epidemic of obesity and diabetes in the USA and around the globe, serious and common diabetic complications are evolving as a major public health problem, particularly among minority populations. These populations are disproportionately affected by diabetes and 2-3 times more likely to develop visually significant complications. In this highly illustrated review article, we discuss the diabetic epidemic, highlighting the biology and the pathophysiologic mechanisms of this disorder on the anatomy of the eye. We also discuss the risk factors and the implications for minority populations. For the health care providers, we provide cutting edge information and imminently relevant information to help evaluate, manage, and know when to refer their patients to a specialist in ophthalmology to quell the tide of the epidemic.
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Affiliation(s)
- Arpine Barsegian
- Department of Ophthalmology, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Boleslav Kotlyar
- Department of Ophthalmology, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Justin Lee
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Moro O Salifu
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Samy I McFarlane
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
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Ayatollahi H, Nourani A, Khodaveisi T, Aghaei H, Mohammadpour M. Teleophthalmology in Practice: Lessons Learned from a Pilot Project. Open Med Inform J 2017; 11:20-28. [PMID: 29081869 PMCID: PMC5633703 DOI: 10.2174/1874431101711010020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/21/2017] [Accepted: 06/02/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Ophthalmology is a medical specialty which may benefit from using telemedicine and teleophthalmology services. Such services are significantly important in the poor, remote, and impassable geographical areas, where there is no access to the ophthalmology services and ophthalmologists. This study aimed to design and implement a teleophthalmology system using the method of store-and-forward. METHODS The study was conducted in 2015 and consisted of two main phases. The first phase was based requirement analysis, and in the second phase, after designing the prototype, an initial usability testing was undertaken in a teaching hospital. The participants of the study were 10 optometrists and 10 ophthalmologists (cornea specialists). For each phase of the research, a questionnaire was used to collect data, and the collected data were analyzed using descriptive statistics. RESULTS In this study, users' requirements were initially investigated. Then, the teleophthalmology system was designed based on the literature review and the results derived from the requirements' analysis. Finally, usability testing showed that the users were relatively satisfied with the system. CONCLUSION According to the results, it can be concluded that the teleophthalmology technology can be used in the country by optometrists and ophthalmologists to improve eye health care services and to prevent the prevalence of curable eye diseases.
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Affiliation(s)
- Haleh Ayatollahi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Nourani
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taleb Khodaveisi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Aghaei
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mohammadpour
- Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Diabetic retinopathy is a leading cause of new-onset vision loss worldwide. Treatments supported by large clinical trials are effective in preserving vision, but many persons do not receive timely diagnosis and treatment of diabetic retinopathy, which is typically asymptomatic when most treatable. Telemedicine evaluation to identify diabetic retinopathy has the potential to improve access to care and improve outcomes, but incomplete implementation of published standards creates a risk to program utility and sustainability. In a prior article, we reviewed the literature regarding the impact of imaging device, number and size of retinal images, pupil dilation, type of image grader, and diagnostic accuracy on telemedicine assessment for diabetic retinopathy. This article reviews the literature regarding the impact of automated image grading, cost effectiveness, program standards, and quality assurance (QA) on telemedicine assessment of diabetic retinopathy. Telemedicine assessment of diabetic retinopathy has the potential to preserve vision, but greater attention to development and implementation of standards is needed to better realize its potential.
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Affiliation(s)
- Mark B Horton
- Joslin Vision Network-Indian Health Service Teleophthalmology Program, Phoenix, AZ, USA.
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Toy BC, Aguinaldo T, Eliason J, Egbert J. Non-Mydriatic Fundus Camera Screening for Referral-Warranted Diabetic Retinopathy in a Northern California Safety-Net Setting. Ophthalmic Surg Lasers Imaging Retina 2016; 47:636-42. [DOI: 10.3928/23258160-20160707-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/06/2016] [Indexed: 11/20/2022]
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Park DW, Mansberger SL. Eye Disease in Patients with Diabetes Screened with Telemedicine. Telemed J E Health 2016; 23:113-118. [PMID: 27328169 DOI: 10.1089/tmj.2016.0034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Telemedicine with nonmydriatic cameras can detect not only diabetic retinopathy but also other eye disease. OBJECTIVE To determine the prevalence of eye diseases detected by telemedicine in a population with a high prevalence of minority and American Indian/Alaskan Native (AI/AN) ethnicities. SUBJECTS AND METHODS We recruited diabetic patients 18 years and older and used telemedicine with nonmydriatic cameras to detect eye disease. Two trained readers graded the images for diabetic retinopathy, age-related macular degeneration (ARMD), glaucomatous features, macular edema, and other eye disease using a standard protocol. We included both eyes for analysis and excluded images that were too poor to grade. RESULTS We included 820 eyes from 424 patients with 72.3% nonwhite ethnicity and 50.3% AI/AN heritage. While 283/424 (66.7%) patients had normal eye images, 120/424 (28.3%) had one disease identified; 15/424 (3.5%) had two diseases; and 6/424 (1.4%) had three diseases in one or both eyes. After diabetic retinopathy (104/424, 24.5%), the most common eye diseases were glaucomatous features (44/424, 10.4%) and dry ARMD (24/424, 5.7%). Seventeen percent (72/424, 17.0%) showed eye disease other than diabetic retinopathy. CONCLUSIONS Telemedicine with nonmydriatic cameras detected diabetic retinopathy, as well as other visually significant eye disease. This suggests that a diabetic retinopathy screening program needs to detect and report other eye disease, including glaucoma and macular disease.
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Affiliation(s)
- Dong-Wouk Park
- 1 Legacy Devers Eye Institute , Legacy Health, Portland, Oregon.,2 Casey Eye Institute, Oregon Health and Science University , Portland, Oregon
| | - Steven L Mansberger
- 1 Legacy Devers Eye Institute , Legacy Health, Portland, Oregon.,2 Casey Eye Institute, Oregon Health and Science University , Portland, Oregon.,3 Department of Public Health and Preventive Medicine, Oregon Health and Science University , Portland, Oregon
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SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE. Retina 2016; 36:1000-8. [DOI: 10.1097/iae.0000000000000955] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diabetic retinopathy screening: the first telemedical approach in an Italian hospital. Eur J Ophthalmol 2015; 26:369-74. [PMID: 26692067 DOI: 10.5301/ejo.5000719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the feasibility of a telemedical approach for diabetic retinopathy (DR) screening in the Italian population and to evaluate advantages/disadvantages in comparison to standard slit-lamp funduscopic examination (SFE). METHODS This 1-year, Italian, single-center, observational study evaluated semiautomatic fundus photography (FP) DR screening, performed during routine type 2 diabetes (T2D) systemic visits and examined remotely. Adults with T2D underwent SFE and 3-field FP. The study was divided into 2 stages (stage 1 validated the screening procedure, stage 2 evaluated the screening impact on the clinical practice). Annual costs of SFE ± FP screening were compared. Patients completed a DR screening questionnaire. RESULTS Of 1,281 T2D patients enrolled, 61% were male (mean age 65.69 ± 12.64 years). In stage 1, 71% and 15% of patients were considered nongradable when FP was performed before (BPD) versus after pupil dilation (APD). The FP specificity was higher with APD vs BPD (79% vs 25%); therefore, FP APD only was used for stage 2. Of 1,281 patients screened using FP APD, 240 (18.7%) had unreadable images; 64.3% did not have DR, and 17.0% were diagnosed with DR. There was a cost saving of €801.25 when screening was performed using FP. Overall, 98% of patients had a positive opinion of FP screening. CONCLUSIONS The telemedicine approach provides a convenient, simple test that is well-received by patients and minimizes unnecessary referrals. Telemedicine may also reduce screening costs in our setting.
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Mansberger SL, Sheppler C, Barker G, Gardiner SK, Demirel S, Wooten K, Becker TM. Long-term Comparative Effectiveness of Telemedicine in Providing Diabetic Retinopathy Screening Examinations: A Randomized Clinical Trial. JAMA Ophthalmol 2015; 133:518-25. [PMID: 25741666 DOI: 10.1001/jamaophthalmol.2015.1] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. OBJECTIVE To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS From August 1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAIN OUTCOMES AND MEASURES Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 (none) to stage 4 (proliferative diabetic retinopathy), and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse, the presence of macular edema, or an unable-to-determine result for retinopathy or macular edema. RESULTS The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P < .001) and greater than 6-month through 18-month (53.0% [157/296] vs 33.2% [90/271]; 95% CI, 16.5%-23.1%; P < .001) time bins. After we offered telemedicine to both groups, we could not identify a difference between the groups in the percentage of diabetic retinopathy screening examinations. Diabetic retinopathy worsened by 2 stages or more in 35 (8.6%) of 409 participants (95% CI, 5.8%-11.2%) and improved by 2 stages or more in 5 (1.2%) of 409 participants (95% CI, 0.1%-2.3%) during the 4-year period. The percent of telemedicine participants requiring referral ranged from 19.2% (52/271) to 27.9% (58/208). CONCLUSIONS AND RELEVANCE Telemedicine increased the percentage of diabetic retinopathy screening examinations, most participants did not require referral to an eye care professional, and diabetic retinopathy levels were generally stable during the study period. This finding suggests that primary care clinics can use telemedicine to screen for diabetic retinopathy and monitor for disease worsening over a long period. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01364129.
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Affiliation(s)
- Steven L Mansberger
- Devers Eye Institute/Discoveries in Sight, Legacy Health, Portland, Oregon2Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Christina Sheppler
- Devers Eye Institute/Discoveries in Sight, Legacy Health, Portland, Oregon
| | - Gordon Barker
- Devers Eye Institute/Discoveries in Sight, Legacy Health, Portland, Oregon
| | - Stuart K Gardiner
- Devers Eye Institute/Discoveries in Sight, Legacy Health, Portland, Oregon
| | - Shaban Demirel
- Devers Eye Institute/Discoveries in Sight, Legacy Health, Portland, Oregon
| | | | - Thomas M Becker
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
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Romero-Aroca P, Sagarra-Alamo R, Pareja-Rios A, López M. Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists. World J Diabetes 2015; 6:1005-1008. [PMID: 26240697 PMCID: PMC4515440 DOI: 10.4239/wjd.v6.i8.1005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 02/05/2023] Open
Abstract
Diabetic retinopathy (DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus (DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters (glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR (6.96%) and diabetic macular edema (6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs.
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Creuzot-Garcher C, Martin-Phipps T, Beynat J, Astruc K, Brassac K, Bron AM. Effectiveness of a mobile diabetic retinopathy screening campaign to encourage diabetics to undergo regular ophthalmic follow-up. Ophthalmic Res 2014; 52:206-11. [PMID: 25402747 DOI: 10.1159/000363326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/26/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the effectiveness of a mobile diabetic retinopathy (DR) screening campaign with a non-mydriatic camera to encourage diabetics to undergo a subsequent ophthalmic follow-up. METHODS Diabetic patients who underwent free DR screening with a non-mydriatic fundus camera were given the recommendation to have an ophthalmic visit, in a time frame suited to the DR stage or in case abnormalities in the macula, the optic nerve or intra-ocular pressure were detected. The photographs were performed by a trained orthoptist. The date of the visit to their ophthalmologist and the report of this consultation were recorded. RESULTS During 5 annual campaigns, 4,699 diabetics were screened. Of the 1,573 ophthalmic examinations recommended at the screening, 1,241 (79%) were actually conducted. A total of 623 new cases of DR were found in the course of this screening campaign, with a fair concordance between the diagnosis suggested at screening and the examination by the ophthalmologist (κ = 0.48). CONCLUSION Information and recommendations given during DR screening helped to reintroduce patients to a regular ophthalmic follow-up, at least in the short term.
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Goudie C, Lunt D, Reid S, Sanders R. Ophthalmic digital image transfer: benefits to triage, patient care and resource. Ophthalmic Physiol Opt 2014; 34:628-35. [PMID: 25223370 DOI: 10.1111/opo.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/13/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Hospital capacity in the UK is currently significantly challenged due to new treatments, targets and resource limitations. There have been significant improvements in training, equipment and shared care services in community primary care optometry services. Despite this the challenges to ophthalmic service delivery are considerable. One area of potential benefit is the effect on outcome when a clinical image is attached to a referral. We aimed to quantify the effect of attaching digital images to ophthalmic referrals. METHODS Retrospective analysis of 358 consecutive optometry referrals to the Hospital Eye Service in Dunfermline, Scotland using electronic referral with digital images. All images were screened by consultant ophthalmologists. RESULTS The patients were aged between 9 and 100 years (mean age 63.6 years). Sixty four (18%) referrals were deemed urgent (requiring appointment within 24-60 h), with the majority, 28 (8%) being wet macular degeneration. One hundred and seventy (48%) were deemed routine (appointment within 2-6 weeks), with categories including macular disease, glaucoma, cataract, optic disc and retinal abnormalities. Twenty seven (8%) patients were already attending the hospital eye service, or had been referred previously for the same condition. Categories were mainly glaucoma, diabetic retinopathy and cataract. Ninety-five (25%) were 'e-diagnosed' based on image and referral information (i.e. with no secondary eye care appointment). Diagnosis included glaucoma suspect (22, 6%), macular pathology (12, 3%), abnormal looking discs (9, 2.5%) and cataract (9, 2.5%). The overall 'did not attend' rate for those patients seen in the hospital eye service (254) was <1% (two patients). CONCLUSIONS The attachment of digital images improved the quality of referral triaging from optometry to secondary eye care in the hospital eye service. It allowed detection of sight threatening disease early and more appropriate allocation of patients to specific specialist clinics at first visit. They allowed safe and speedy 'e-diagnosis' of a subgroup, saving hospital capacity and minimising patient inconvenience. Indirectly the service also reduced the 'did not attend' rate. With recent improvements in camera and internet technology digital images will have an ever increasing role in secondary eye care as it continues to adapt to meet modern demands.
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Affiliation(s)
- Colin Goudie
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Scotland, UK
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Mansberger SL, Gleitsmann K, Gardiner S, Sheppler C, Demirel S, Wooten K, Becker TM. Comparing the effectiveness of telemedicine and traditional surveillance in providing diabetic retinopathy screening examinations: a randomized controlled trial. Telemed J E Health 2013; 19:942-8. [PMID: 24102102 DOI: 10.1089/tmj.2012.0313] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of telemedicine for providing diabetic retinopathy screening examinations compared with the effectiveness of traditional surveillance in community health clinics with a high proportion of minorities, including American Indian/Alaska Natives. SUBJECTS AND METHODS We conducted a multicenter, randomized controlled trial and assigned diabetic participants to one of two groups: (1) telemedicine with a nonmydriatic camera or (2) traditional surveillance with an eye care provider. For those receiving telemedicine, the criteria for requiring follow-up with an eye care provider were (1) moderate nonproliferative diabetic retinopathy or higher, (2) presence of clinically significant macular edema, or (3) "unable to grade" result for diabetic retinopathy or macular edema. RESULTS The telemedicine group (n=296) was more likely to receive a diabetic retinopathy screening examination within the first year of enrollment compared with the traditional surveillance group (n=271) (94% versus 56%, p<0.001). The overall prevalence of diabetic retinopathy at baseline was 21.4%, and macular edema was present in 1.4% of participants. In the telemedicine group, 20.5% would require further evaluation with an eye care provider, and 86% of these referrals were because of poor-quality digital images. CONCLUSIONS Telemedicine using nonmydriatic cameras increased the proportion of participants who obtained diabetic retinopathy screening examinations, and most did not require follow-up with an eye care provider. Telemedicine may be a more effective way to screen patients for diabetic retinopathy and to triage further evaluation with an eye care provider. Methods to decrease poor quality imaging would improve the effectiveness of telemedicine for diabetic retinopathy screening examinations.
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Affiliation(s)
- Steven L Mansberger
- 1 Devers Eye Institute/Discoveries in Sight , Legacy Health, Portland, Oregon
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Andonegui J, Zurutuza A, de Arcelus MP, Serrano L, Eguzkiza A, Auzmendi M, Gaminde I, Aliseda D. Diabetic retinopathy screening with non-mydriatic retinography by general practitioners: 2-year results. Prim Care Diabetes 2012; 6:201-205. [PMID: 22285305 DOI: 10.1016/j.pcd.2012.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/29/2011] [Accepted: 01/04/2012] [Indexed: 11/24/2022]
Abstract
AIMS To ascertain in real practice the diagnosis rate of diabetic retinopathy (DR) in patients considered to have positive screening test by general practitioners (GPs) and what are the reasons for the false positive diagnosis. METHODS Four GPs previously instructed in the interpretation of retinal photographs evaluated the digital retinography images of patients with diabetes obtained during a 2-year period. When the images were considered normal, a new appointment was scheduled for 1 year later and a report was emailed to the referring physician. Patients with any sign of DR or other suspicious retinal alterations and those whose images were considered difficult or impossible to assess were referred to an ophthalmologist. RESULTS A total of 2750 patients were referred for screening. The images of 2036 (74%) patients were considered normal, and the images of 714 (26%) patients were sent to ophthalmologists. Among the referred patients, 392 (55%) did not have DR, 244 (34%) had DR, and 78 (11%) had unreadable images. The retinal images of 240 patients whose fundi were considered normal were read again by ophthalmologists to evaluate false negatives. Of them, 16 patients (7%) had DR but only two patients (1%) had treatable DR. CONCLUSIONS After adequate training, GPs can screen for DR with a high level of accuracy using non-mydriatic retinography. There is a need to strengthen the training of GPs in order to recognize non-visual threatening abnormalities.
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Affiliation(s)
- Jose Andonegui
- Department of Ophthalmology, Complejo Hospitalario de Navarra, Pamplona, Spain.
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Martínez Rubio M, Moya Moya M, Bellot Bernabé A, Belmonte Martínez J. [Diabetic retinopathy screening and teleophthalmology]. ACTA ACUST UNITED AC 2012; 87:392-5. [PMID: 23121699 DOI: 10.1016/j.oftal.2012.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 02/28/2012] [Accepted: 04/08/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the prevalence of diabetic retinopathy (DR) and evaluate our experience in DR screening in a study carried out between the Ophthalmology Department of the University General Hospital of Alicante and Department 19 Primary Care of Alicante by using a non-retinal mydriatic camera and telemedicine. MATERIAL AND METHODS A descriptive, cross-sectional study was conducted on 2,435 diabetic patients from 1 February 2006 to 1 February 2009. Three 45° retinographies of both eyes of each patient were obtained and sent to the Department of Ophthalmology via the hospital intranet. These were then evaluated by 2 ophthalmologists, experts in the retina, with each issuing an individualized report for each patient. RESULTS The prevalence of DR was 17.90%, with 80.73% of them having mild-moderate proliferative DR, 12.16% severe non-proliferative DR, 2.29% proliferative DR, and 4.82% with diabetic maculopathy associated with any level of retinopathy. The retinographies were considered low quality in 41 patients (1.69%). CONCLUSIONS We highlight the benefits of the tele-ophthalmology in screening diabetic patients to enable early diagnosis and treatment, and improving the circuit of communication between primary and specialist care.
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Affiliation(s)
- M Martínez Rubio
- Servicio Oftalmología, Hospital General Universitario Alicante, Alicante, España.
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RETIDIAB®: Assessment of a continuing medical education website for the improvement of diabetic retinopathy management. DIABETES & METABOLISM 2011; 37:118-23. [DOI: 10.1016/j.diabet.2010.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 11/16/2022]
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Tran THC, Rahmoun J, Hui Bon Hoa AA, Denimal F, Delecourt F, Jean Jean E, Forzy G. [Screening for diabetic retinopathy using a three-field digital nonmydriatic fundus camera in the North of France]. J Fr Ophtalmol 2010; 32:735-41. [PMID: 19944483 DOI: 10.1016/j.jfo.2009.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate screening for diabetic retinopathy, using three-field nonmydriatic fundus photography, combined with telemedicine, in two hospitals. METHODS Patients from the Endocrinology Department of Saint Philibert Hospital were screened consecutively from March 2007 to September 2008. Three 45 degrees digital images per eye examination were taken using a nonmydriatic fundus camera and sent by intranet to the Department of Ophthalmology of Saint Vincent de Paul Hospital for grading by two ophthalmologists. RESULTS A total of 1147 patients (52% males, 48% females) were screened. The mean age was 60 years (range, 19-92 years). Most patients had type 2 diabetes (n=1000; 90%). The mean HbA1c was 8%. Microalbuminuria was detected in 239 patients (20.8%). Of these 1147 patients, 521 (45%) said they had never had a fundus examination before. Fundus photography of at least one eye could not be graded in 160 patients (14%). Diabetic retinopathy was detected in 187 patients (19%). Suspected macular edema (hard exudates within one disc diameter of the macular center) was found in 38 patients (3.8%). Referral to an ophthalmologist was required in 347 patients (30%) for diabetic retinopathy and unreadable photographs. During the period of the study, 107 patients had both three-field nonmydriatic photography and dilated funduscopy, which was used as reference. Agreement between the two readers was 0.97. CONCLUSIONS Nonmydriatic photography combined with telemedicine is useful for screening for diabetic retinopathy and identifies patients requiring further complete eye examination. Good collaboration between the two centers is required to improve the follow-up after screening in the future.
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Affiliation(s)
- T H C Tran
- Service d'ophtalmologie, Hôpital Saint Vincent de Paul, Groupe hospitalier de l'institut catholique de Lille, Boulevard Belfort, Lille Cedex.
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How to improve screening for diabetic retinopathy: The Burgundy experience. DIABETES & METABOLISM 2010; 36:114-9. [DOI: 10.1016/j.diabet.2009.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 08/26/2009] [Accepted: 09/02/2009] [Indexed: 11/18/2022]
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Lemmetty R, Mäkelä K. Mobile digital fundus screening of type 2 diabetes patients in the Finnish county of South-Ostrobothnia. J Telemed Telecare 2009; 15:68-72. [PMID: 19246605 DOI: 10.1258/jtt.2008.080804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In 1999 we introduced a digital, mobile eye fundus camera for screening type 2 diabetes mellitus patients (adult onset diabetes) in the Finnish county of South-Ostrobothnia. Prior to this, eye fundus examinations were only available in the regional central hospital, and no systematic screening of type 2 (adult onset) diabetes patients was possible. The total number of screenings carried out with the mobile equipment from 1999 to 2006 was 17,471 cases. There were significant benefits, most important from improved coverage of type 2 diabetes patients. Because the mobile system made eye fundus examinations available to patients in their nearest health centre, approximately 85% of all patients with diabetes in the region are now screened. On average this means that each patient is screened once every 2.5 years, which is in line with national recommendations. As a result, more of the earlier stage retinopathy cases have been diagnosed. There have also been changes in the frequency and type of procedures at the eye department of the regional central hospital. The number of cases referred to the eye department for follow-up studies has decreased from 49 in 2000 to 19 in 2005. The screening system adopted in South-Ostrobothnia has had beneficial effects for both patients and health-care providers.
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Affiliation(s)
- Riku Lemmetty
- Tampere University of Technology, Department of Biomedical Engineering, Telemedicine Laboratory, Koskenalantie 16, Seinäjoki, Finland
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Nsiah-Kumi P, Ortmeier SR, Brown AE. Disparities in Diabetic Retinopathy Screening and Disease for Racial and Ethnic Minority Populations—A Literature Review. J Natl Med Assoc 2009; 101:430-7. [DOI: 10.1016/s0027-9684(15)30929-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera. DIABETES & METABOLISM 2009; 35:49-56. [DOI: 10.1016/j.diabet.2008.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Revised: 06/13/2008] [Accepted: 07/04/2008] [Indexed: 11/21/2022]
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Luis-Ruiz C, Rufino-Delgado M, Navarro-Brito E, Real-Valcárcel E. Telemedicina en Atención Primaria: evaluación de la retinopatía diabética en una Zona Básica de Salud. Semergen 2009. [DOI: 10.1016/s1138-3593(09)70176-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soto-Pedre E, Hernaez-Ortega MC. Screening coverage for diabetic retinopathy using a three-field digital non-mydriatic fundus camera. Prim Care Diabetes 2008; 2:141-146. [PMID: 18779038 DOI: 10.1016/j.pcd.2008.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 03/17/2008] [Accepted: 04/28/2008] [Indexed: 11/21/2022]
Abstract
AIMS Guidelines for regular screening of diabetic retinopathy (DR) have been published in the Spanish and European literature since 1992, but screening for DR is still in its early stages in Spain. The aim of this paper is to estimate the prevalence of screening coverage for DR and prevalence of DR itself using three-field digital non-mydriatic fundus photography to determine whether these guidelines had been implemented. METHODS Data on age, gender, diabetes and previous eye examinations were recorded on a specially designed questionnaire. Three 45 degrees digital images per eye were taken using a three-field digital non-mydriatic fundus camera with two photographic procedures (both eyes versus the eye with the poorer visual acuity). RESULTS A total of 183 patients with diabetes participated. The median age and duration of diabetes was 63 years and 10 years, respectively. Only six patients (3.3%) could not be completely graded. Screening coverage for DR was 38.5% in patients with type 2 diabetes and a duration less than 5 years versus those with longer diabetes duration (P=0.007); 20.5% of these patients had DR. CONCLUSIONS This study highlights the need for heightened awareness of the importance of screening for retinopathy in people with type 2 diabetes and duration of diabetes under 5 years.
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Massin P, Chabouis A, Erginay A, Viens-Bitker C, Lecleire-Collet A, Meas T, Guillausseau PJ, Choupot G, André B, Denormandie P. OPHDIAT: a telemedical network screening system for diabetic retinopathy in the Ile-de-France. DIABETES & METABOLISM 2008; 34:227-34. [PMID: 18468470 DOI: 10.1016/j.diabet.2007.12.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 12/02/2007] [Accepted: 12/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE International and national guidelines recommend an annual funduscopic examination for all diabetic patients, but such annual fundus examinations are not sufficiently performed in France. Non-mydriatic fundus photography is a valid method of evaluation for diabetic retinopathy (DR) and a viable alternative to ophthalmoscopy. After two pilot studies demonstrated the feasibility of telemedical screening for diabetic retinopathy in both hospital and primary-care settings, we developed a regional telemedical network, OPHDIAT, designed to facilitate access to regular annual evaluations of patients with diabetes while saving medical time. MATERIALS AND METHODS OPHDIAT comprises peripheral screening centres equipped with non-mydriatic cameras, where fundus photographs are taken by technicians linked by telemedicine to a reference centre, where ophthalmologists grade the images. Currently in the Ile-de-France region, 16 screening centres are linked through a central server to an ophthalmologic reading centre and includes 11 centres located in the diabetes departments of 11 hospitals, one diabetic retinopathy screening centre located in northern Paris, three in healthcare centres and one in a prison. RESULTS During the 28-month evaluation period, 15,307 DR screening examinations were performed. Retinal photographs of at least one eye could not be graded in 1332 patients (9.7%) and diabetic retinopathy was detected in 3350 patients (23.4%). After the screening examination, 3478 patients (25.2%) were referred to an ophthalmologist for either DR, cataract and/or non-gradable photographs. CONCLUSION Fundus photography combined with telemedicine has the potential to improve the regular annual evaluation for diabetic retinopathy. The organization of the network around a central reading centre serves to guarantee quality control.
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Affiliation(s)
- P Massin
- Ophthalmology department, hôpital Lariboisière, université Paris-VII, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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Pasquale LR, Asefzadeh B, Dunphy RW, Fisch BM, Conlin PR. Detection of glaucoma-like optic discs in a diabetes teleretinal program. ACTA ACUST UNITED AC 2008; 78:657-63. [PMID: 18054136 DOI: 10.1016/j.optm.2007.04.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 03/30/2007] [Accepted: 04/16/2007] [Indexed: 12/19/2022]
Abstract
BACKGROUND Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc. METHODS Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma. RESULTS Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs. CONCLUSIONS Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.
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Affiliation(s)
- Louis R Pasquale
- Ocular Telehealth Center, VA Boston Healthcare System-Jamaica Plain Campus, Jamaica Plain, Massachusetts 02130, USA.
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Lecleire-Collet A, Erginay A, Angioi-Duprez K, Deb-Joardar N, Gain P, Massin P. Classification simplifiée de la rétinopathie diabétique adaptée au dépistage par photographies du fond d’œil. J Fr Ophtalmol 2007; 30:674-87. [PMID: 17878820 DOI: 10.1016/s0181-5512(07)91355-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Fundus photographs using a nonmydriatic digital camera are the reference method for diabetic retinopathy screening today. The aim of this study was to validate a simplified diabetic retinopathy classification, adapted for diabetic retinopathy screening, including all diabetic retinopathy severity scales. PATIENTS AND METHODS One hundred and twenty-one diabetic patients had three digital color fundus photographs taken, which were graded by four independent ophthalmologists according to the proposed screening classification, and a reference examination (nine field fundus photographs and optical coherence tomography examination of the macula). RESULTS The proposed diabetic retinopathy screening classification was easy to use, as it was based on a visual comparison between the three digital color fundus photographs and standard retinal photographs. This classification provided the diagnosis of severe levels of diabetic retinopathy with high sensitivity and accurate specificity (100% and 50%-58%,respectively, for a moderate nonproliferative diabetic retinopathy level or higher on the screening examination) and the diagnosis of macular edema with a high sensitivity and specificity (96%-97% and 89%-91%, respectively). The results of the screening examination using this classification were highly reproducible (weighted k for interobserver agreement: 0.78-0.93). CONCLUSION These results suggest that this new simplified classification is accurate. The screening method should not be used above the threshold level of mild nonproliferative diabetic retinopathy. Thus, from the moderate nonproliferative level (inclusive), a complete fundus examination should be undertaken. Severe levels of diabetic retinopathy will be referred to an ophthalmologist without delay for laser treatment.
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Deb-Joardar N, Germain N, Thuret G, Garcin AF, Manoli P, Defreyn A, Gain P, Estour B. Systematic screening for diabetic retinopathy with a digital fundus camera following pupillary dilatation in a university diabetes department. Diabet Med 2007; 24:303-7. [PMID: 17263768 DOI: 10.1111/j.1464-5491.2006.02030.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Screening for diabetic retinopathy (DR) is highly inadequate in France because of insufficient infrastructure and increasing disease prevalence. We describe the results of the first systematic DR screening programme established in a university diabetes department. METHODS In this cross-sectional study conducted over 1 year, consecutive adult patients underwent three-field retinal photography with the Topcon TRC NW6S digital fundus camera following pupillary dilatation with Tropicamide 1%. A questionnaire provided information on patients' systemic and ocular history. Glycated haemoglobin (HbA1c) was measured at the screening visit. Two ophthalmologists graded the retinal photographs in a masked fashion. RESULTS Of 1157 patients attending the diabetes department, 1153 (99.7%)underwent photographic screening. Images were gradable in 96% patients. Diabetic retinopathy was detected in 522 (45%) patients and sight-threatening DR in 167 (14%). Of 704 (61%) patients previously believed to have no DR,254 (34%) screened positive. The presence of DR was associated with age,insulin use and non-Caucasian ethnicity in Type 2 patients, and with duration of diabetes and HbA1c in Type 1 and Type 2 patients. Associated ocular pathologies were diagnosed in 612 (53%) patients. CONCLUSIONS Our photographic screening programme using pharmacological mydriasis provided a high screening coverage feasible in a hospital setting. We obtained information regarding prevalence and associated risk factors of DR inpatients attending a tertiary care centre. Screening was well accepted by patients and met with no protest from city ophthalmologists. It generated considerable interest among endocrinologists and feedback of results is expected to improve optimization of glycaemic control.
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Affiliation(s)
- N Deb-Joardar
- Department of Ophthalmology, University Hospital Bellevue, Saint-Etienne, France
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Current literature in diabetes. Diabetes Metab Res Rev 2005; 21:475-82. [PMID: 16114072 DOI: 10.1002/dmrr.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Deb-Joardar N, Germain N, Thuret G, Garcin AF, Manoli P, Estour B, Gain P. Detection of associated ocular lesions during screening of diabetic retinopathy. Diabetes Care 2005; 28:2334-5. [PMID: 16123521 DOI: 10.2337/diacare.28.9.2334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Massin P, Aubert JP, Eschwege E, Erginay A, Bourovitch JC, BenMehidi A, Nougarède M, Bouée S, Fagnani F, Tcherny MS, Jamet M, Bouhassira M, Marre M. Evaluation of a screening program for diabetic retinopathy in a primary care setting Dodia (Dépistage ophtalmologique du diabète) study. DIABETES & METABOLISM 2005; 31:153-62. [PMID: 15959421 DOI: 10.1016/s1262-3636(07)70181-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this observational study was to evaluate the screening for diabetic retinopathy (DR) using eye fundus photography taken by a nonmydriatic camera and transmitted trough the Internet to an ophthalmological reading centre, as compared to a dilated eye examination performed by an ophthalmologist. METHODS A total of 456 and 426 diabetic patients were included by two different groups of primary care physicians (PCPs), 358 being screened with the non-mydriatic camera (experimental group) and 320 with dilated eye fundus exam (control group). RESULTS The proportion of screened patients for whom PCPs received a screening report within the 6-month follow-up period was 74,1% for the experimental group and 71,5% for the control group. Screening for DR was negative in 77,6% of patients with eye fundus photographs vs 89,6% with dilated eye examination. DR was diagnosed in 62 patients (17,3%) with eye fundus photographs versus 31 with dilated eye examination (10,4%). Referral to an ophthalmologist was required in 59 reports of patients with photographs (16.5%), 23 of them due to high grade DR. Finally, the non-mydriatic camera was found of little inconvenience by patients. CONCLUSION The telemedical approach to DR screening proved to be effective in providing primary care practitioners with information about their patient's eye status. This screening method allowed to identify patients requiring prompt referral to the ophthalmologist for further complete eye examination. In conclusion, this study provided successful results of DR screening using fundus photography in primary care patients, and strongly supports the need to further extend this screening program in a larger number of French sites.
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Affiliation(s)
- P Massin
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris Cedex 10, France.
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