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Remote undilated retinal imaging improved yearly exam rates for diabetic patients
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Nonmydriatic teleretinal imaging significantly improved adherence to annual comprehensive dilated follow-up exams among patients with diabetes, a randomized study found. Systems that allow remote undilated imaging may offer a time- and cost-efficient means for detecting patients with proliferative diabetic retinopathy, the study authors said.
Paul R. Conlin, MD, of the Department of Veterans Affairs Boston Healthcare System, and colleagues compared the rates of annual dilated eye exams in 223 patients assigned to undergo teleretinal imaging and 225 control patients who continued with usual care.
Teleretinal imaging was performed using the Joslin Vision Network system, which uses a digital retinal camera to capture stereoscopic single-frame images of three 45° retinal fields. It also captures an external image of each eye for evaluating ocular media clarity and the lids, lashes and orbital adnexa, according to the study authors.
After being imaged, patients were shown their ocular anatomy and were educated on the importance of glucose and blood pressure control. The images were transmitted to retina specialists who graded them for clinical levels of diabetic retinopathy.
The researchers found that 87% of patients in the teleretinal imaging group underwent a follow-up exam within 12 months of randomization, a significantly higher percentage than control patients (77%; P < .01). Follow-up exams occurred an average of 172 days after group assignment for those in the teleretinal imaging group and 200 days for control patients (P < .08), according to the study authors.
Teleretinal imaging captured fully gradable images in 143 patients (63%). Adherence rates were not significantly different between patients with and without gradable images. Cataract and smaller pupil size were associated with ungradable images.
The authors attribute the improved adherence among patients in the imaging group to the frequent identification of new cases of diabetic retinopathy and nondiabetic ocular disorders, and to the educational component of the imaging session. Imaging technicians also contacted patients with follow-up reminders when appropriate.
In a cost-effectiveness analysis, teleretinal imaging "was the dominant strategy ... meaning that it was less costly and more effective for detecting proliferative DR," than dilated fundus exams, the authors said.
The study is published in the September/October issue of the Journal of Rehabilitation Research & Development.