Tele-screening for diabetic retinopathy found feasible, effective
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Among diabetes care centers in India, screening for diabetic retinopathy using tele-ophthalmology proved feasible and effective for sight-threatening diabetic retinopathy, according to study results.
Ramachandran Rajalakshmi, PhD, of Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation in Chennai, India, and colleagues conducted the observational, multicenter, retrospective, cross-sectional study. The researchers performed diabetic retinopathy screening in patients with diabetes at 35 branches of a chain of diabetes care centers in 20 cities in India for 1 year.
The researchers performed diabetic retinopathy screening with tele-ophthalmology, which consisted of retinal images obtained via Fundus on Phone camera; images were then uploaded through the telemedicine network for centralized diabetic retinopathy grading from eight retina specialists. In a second study group, the same retina specialists performed diabetic retinopathy screening via fundus examination at five centers.
Researchers compared the rate of detection of sight-threatening diabetic retinopathy — defined as the presence of proliferative diabetic retinopathy and/or diabetic macular edema — between the two groups.
The study involved 58,612 adults who were screened in 2018. Of the participants, 25,316 received tele-ophthalmology (mean age, 55.8 years; mean diabetes duration, 9.5 years) and 33,296 received fundus examination (mean age, 57.5 years; mean diabetes duration, 11.5 years).
Mean HbA1c was 8.8% in the tele-ophthalmology arm and 8.5% in the fundus examination arm. Researchers observed any diabetic retinopathy in 31.7% (95% CI, 31-32.3) of the tele-screening group and 38.5% (95% CI, 37.9-39) of the fundus examination group, and sight-threatening diabetic retinopathy in 7.3% (95% CI, 7-7.7) of the tele-screening group and 10.5% (95% CI, 10.2-10.9) of the fundus examination group.
In all, researchers advised referral to retina specialists for further management in 11.4% of individuals with diabetes in the tele-ophthalmology group, which included 4.1% with ungradable images.
“Targeted screening using tele-ophthalmology in diabetes care centers is a valuable strategy for diabetic retinopathy detection in India,” Rajalakshmi and colleagues concluded. “This study provides evidence that adding tele-ophthalmology to the diabetes care model should be scaled up throughout India to enable rapid coverage of diabetic retinopathy screening in any setting (government, private and charitable institutions) treating diabetes and the comorbidities.”
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