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.
RCT Entities:
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 diabeticparticipants 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.
Authors: Richard M Davis; Stanley Fowler; Kim Bellis; Jeffrey Pockl; Vytautas Al Pakalnis; Andrew Woldorf Journal: Diabetes Care Date: 2003-08 Impact factor: 19.112
Authors: S E Bursell; J D Cavallerano; A A Cavallerano; A C Clermont; D Birkmire-Peters; L P Aiello; L M Aiello Journal: Ophthalmology Date: 2001-03 Impact factor: 12.079
Authors: Helen K Li; Mark Horton; Sven-Erik Bursell; Jerry Cavallerano; Ingrid Zimmer-Galler; Mathew Tennant; Michael Abramoff; Edward Chaum; Debra Cabrera Debuc; Tom Leonard-Martin; Marc Winchester; Mary G Lawrence; Wendell Bauman; W Kelly Gardner; Lloyd Hildebran; Jay Federman Journal: Telemed J E Health Date: 2011-10-04 Impact factor: 3.536
Authors: C P Wilkinson; Frederick L Ferris; Ronald E Klein; Paul P Lee; Carl David Agardh; Matthew Davis; Diana Dills; Anselm Kampik; R Pararajasegaram; Juan T Verdaguer Journal: Ophthalmology Date: 2003-09 Impact factor: 12.079
Authors: Cynthia Owsley; Gerald McGwin; David J Lee; Byron L Lam; David S Friedman; Emily W Gower; Julia A Haller; Lisa A Hark; Jinan Saaddine Journal: JAMA Ophthalmol Date: 2015-02 Impact factor: 7.389
Authors: Martha E Ryan; Ramachandran Rajalakshmi; Vijayaraghavan Prathiba; Ranjit Mohan Anjana; Harish Ranjani; K M Venkat Narayan; Timothy W Olsen; Viswanathan Mohan; Laura A Ward; Michael J Lynn; Andrew M Hendrick Journal: Ophthalmology Date: 2015-07-16 Impact factor: 12.079
Authors: Steven L Mansberger; Christina Sheppler; Gordon Barker; Stuart K Gardiner; Shaban Demirel; Kathleen Wooten; Thomas M Becker Journal: JAMA Ophthalmol Date: 2015-05 Impact factor: 7.389
Authors: Patrice M Hicks; Samuel A Collazo Melendez; Albert Vitale; William Self; Mary Elizabeth Hartnett; Paul Bernstein; Denise J Morgan; Michael Feehan; Akbar Shakoor; Ivana Kim; Leah A Owen; Margaret M DeAngelis Journal: J Community Med Public Health Date: 2019-06-10
Authors: Atsushi Kawaguchi; Noha Sharafeldin; Aishwarya Sundaram; Sandy Campbell; Matthew Tennant; Christopher Rudnisky; Ezekiel Weis; Karim F Damji Journal: Telemed J E Health Date: 2017-08-07 Impact factor: 3.536