|
1
|
Gonzalez Sepulveda JM, Yang JC, Mastylak A, Wells-Gray EM, Grace L, Fransen S. Quantifying Patient Preferences and Expectations About Diabetic Retinopathy Monitoring. JAMA Ophthalmol 2025; 143:91-98. [PMID: 39699904 PMCID: PMC11842207 DOI: 10.1001/jamaophthalmol.2024.5365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 10/21/2024] [Indexed: 12/20/2024]
Abstract
Importance Diabetic retinopathy (DR) is the leading cause of blindness among adults in the US. The US Centers for Disease Control and Prevention recommends annual DR monitoring for all individuals with diabetes, yet monitoring rates remain below 70%. Objective To evaluate how patient preferences and expectations about DR monitoring are associated with expected monitoring adherence behaviors. Design, Setting, and Participants In this survey study, a web-enabled survey instrument was developed and implemented with a discrete-choice experiment to characterize patient preferences for outcomes of DR monitoring and graded-pair questions to quantify patients' expectations about the impact of DR monitoring on blindness risk. The survey was conducted through ResearchMatch, a US National Institutes of Health-developed online platform, among adults with self-reported, physician-diagnosed diabetes. Recruitment occurred between September 15, 2023, and October, 17, 2023, and data analysis occurred between October 2023 and December 2023. Results from the 2 tasks were combined to derive patients' expected monitoring behavior following a recently proposed treatment adherence framework. The survey instrument was pretested in cognitive interviews and validated for the purposes of this study. Exposure Survey-based discrete-choice experiment and graded-pair questions. Main Outcomes and Measures Participants' relative preferences for DR-related blindness risk reductions, monitoring time, and out-of-pocket monitoring costs were quantified, as well as the degree to which participants expected adherence to monitoring to affect the risk of blindness. By combining how much participants valued specific reductions in blindness risk (relative to monitoring costs) and their expected risk reduction through monitoring, the rate at which patients would maximize the benefit of monitoring appointments was assessed. Results The survey was completed satisfactorily by 304 respondents of 542 individuals invited to participate. Mean (SD) respondent age was 40.5 (11.2) years, and 169 respondents (56.1%) were female. Reductions in blindness risk were valuable to participants. Participants required a 3.87 (95% CI, 1.91-5.88) percentage-point reduction in 5-year blindness risk to be fully adherent to an annual 53-minute monitoring visit with a $26 co-payment, but respondents expected DR monitoring to reduce the 5-year blindness risk by 0.71 (95% CI, 0.21-1.28) percentage points. Conclusions and Relevance In this online survey study among adults with diabetes, measurement of patient preferences and expectations about DR monitoring with properly validated instruments offered an opportunity to assess patient health behaviors. The association between preferences and monitoring expectations was generally consistent with monitoring nonadherence among adults with diabetes and offers insights that may help address inconsistent DR monitoring.
Collapse
Affiliation(s)
- Juan Marcos Gonzalez Sepulveda
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | | |
Collapse
|
|
2
|
Nderitu P, Nunez do Rio JM, Webster L, Mann S, Cardoso MJ, Modat M, Hopkins D, Bergeles C, Jackson TL. Predicting 1, 2 and 3 year emergent referable diabetic retinopathy and maculopathy using deep learning. COMMUNICATIONS MEDICINE 2024; 4:167. [PMID: 39169209 PMCID: PMC11339445 DOI: 10.1038/s43856-024-00590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Predicting diabetic retinopathy (DR) progression could enable individualised screening with prompt referral for high-risk individuals for sight-saving treatment, whilst reducing screening burden for low-risk individuals. We developed and validated deep learning systems (DLS) that predict 1, 2 and 3 year emergent referable DR and maculopathy using risk factor characteristics (tabular DLS), colour fundal photographs (image DLS) or both (multimodal DLS). METHODS From 162,339 development-set eyes from south-east London (UK) diabetic eye screening programme (DESP), 110,837 had eligible longitudinal data, with the remaining 51,502 used for pretraining. Internal and external (Birmingham DESP, UK) test datasets included 27,996, and 6928 eyes respectively. RESULTS Internal multimodal DLS emergent referable DR, maculopathy or either area-under-the receiver operating characteristic (AUROC) were 0.95 (95% CI: 0.92-0.98), 0.84 (0.82-0.86), 0.85 (0.83-0.87) for 1 year, 0.92 (0.87-0.96), 0.84 (0.82-0.87), 0.85 (0.82-0.87) for 2 years, and 0.85 (0.80-0.90), 0.79 (0.76-0.82), 0.79 (0.76-0.82) for 3 years. External multimodal DLS emergent referable DR, maculopathy or either AUROC were 0.93 (0.88-0.97), 0.85 (0.80-0.89), 0.85 (0.76-0.85) for 1 year, 0.93 (0.89-0.97), 0.79 (0.74-0.84), 0.80 (0.76-0.85) for 2 years, and 0.91 (0.84-0.98), 0.79 (0.74-0.83), 0.79 (0.74-0.84) for 3 years. CONCLUSIONS Multimodal and image DLS performance is significantly better than tabular DLS at all intervals. DLS accurately predict 1, 2 and 3 year emergent referable DR and referable maculopathy using colour fundal photographs, with additional risk factor characteristics conferring improvements in prognostic performance. Proposed DLS are a step towards individualised risk-based screening, whereby AI-assistance allows high-risk individuals to be closely monitored while reducing screening burden for low-risk individuals.
Collapse
Affiliation(s)
- Paul Nderitu
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Department of Ophthalmology, King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK.
| | - Joan M Nunez do Rio
- Department of Ophthalmology, King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Laura Webster
- Department of Ophthalmology, South East London Diabetic Eye Screening Service, St Thomas' Hospital, London, UK
| | - Samantha Mann
- Department of Ophthalmology, South East London Diabetic Eye Screening Service, St Thomas' Hospital, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Timothy L Jackson
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| |
Collapse
|
|
3
|
Szulborski KJ, Ramsey DJ. Enhancing diabetic retinopathy screening: Non-mydriatic fundus photography-assisted telemedicine for improved clinical management. World J Diabetes 2024; 15:1820-1823. [PMID: 39192855 PMCID: PMC11346096 DOI: 10.4239/wjd.v15.i8.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/29/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024] Open
Abstract
The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate, efficient, and cost-effective method to improve early detection of disease. It has also been shown to correlate with increased participation of patients in other aspects of diabetes care. In particular, patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics, which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.
Collapse
Affiliation(s)
- Kira J Szulborski
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
- Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, MA 01805, United States
| | - David J Ramsey
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
- Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, MA 01805, United States
- Graduate Faculty, New England College of Optometry, Boston, MA 02115, United States
| |
Collapse
|
|
4
|
Aravindhan A, Fenwick EK, Chan AWD, Man REK, Tan NC, Wong WT, Soo WF, Lim SW, Wee SYM, Sabanayagam C, Finkelstein E, Tan G, Hamzah H, Chakraborty B, Acharyya S, Shyong TE, Scanlon P, Wong TY, Lamoureux EL. Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study. BMC Public Health 2024; 24:786. [PMID: 38481239 PMCID: PMC10935797 DOI: 10.1186/s12889-024-18287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up. METHODS DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated. RESULTS Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline. CONCLUSIONS In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.
Collapse
Affiliation(s)
- Amudha Aravindhan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Aurora Wing Dan Chan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | | | | | | | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Gavin Tan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Tai E Shyong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Peter Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
| |
Collapse
|
|
5
|
Drinkwater JJ, Kalantary A, Turner AW. A systematic review of diabetic retinopathy screening intervals. Acta Ophthalmol 2023. [PMID: 37915115 DOI: 10.1111/aos.15788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
The current evidence on whether annual diabetic retinopathy (DR) screening intervals can be extended was reviewed. A systematic review protocol was followed (PROSPERO ID: CRD42022359590). Original longitudinal articles that specifically assessed DR screening intervals were in English and collected data after 2000 were included. Two reviewers independently conducted the search and reviewed the articles for quality and relevant information. The heterogeneity of the data meant that a meta-analysis was not appropriate. Twelve publications were included. Studies were of good quality and many used data from DR screening programs. Studies fit into three categories; those that assessed specific DR screening intervals, those that determined optimal DR screening intervals and those that developed/assessed DR screening risk equations. For those with type 2 diabetes, extending screening intervals to 3- to 4-yearly in those with no baseline DR appeared safe. DR risk equations considered clinical factors and allocated those at lower risk of DR progression screening intervals of up to five years. Those with baseline DR or type 1 diabetes appeared to have a higher risk of progression to STDR and needed more frequent screening. DR screening intervals can be extended to 3-5 yearly in certain circumstances. These include patients with type 2 diabetes and no current DR, and those who have optimal management of other risk factors such as glucose and blood pressure.
Collapse
Affiliation(s)
- Jocelyn J Drinkwater
- Center for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Amy Kalantary
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Angus W Turner
- Center for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| |
Collapse
|
|
6
|
Szulborski KJ, Gumustop S, Lasalle CC, Hughes K, Roh S, Ramsey DJ. Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting. Vision (Basel) 2023; 7:53. [PMID: 37606499 PMCID: PMC10443374 DOI: 10.3390/vision7030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Regular eye examinations to screen for the initial signs of diabetic retinopathy (DR) are crucial for preventing vision loss. Teleretinal imaging (TRI) offered in a primary care setting provides a means to improve adherence to DR screening, particularly for patients who face challenges in visiting eye care providers regularly. The present study evaluates the utilization of TRI to screen for DR in an outpatient, hospital-based primary care clinic. Patients with diabetes mellitus (DM) but without DR were eligible for point-of-care screening facilitated by their primary care provider, utilizing a non-mydriatic, handheld fundus camera. Patient demographics and clinical characteristics were extracted from the electronic medical record. Patients who underwent TRI were more likely to be male, non-White, and have up-to-date monitoring and treatment measures, including hemoglobin A1c (HbA1c), microalbumin, and low-density lipoprotein (LDL) levels, in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. Our findings demonstrate that TRI can reduce screening costs compared to a strategy where all patients are referred for in-person eye examinations. A net present value (NPV) analysis indicates that a screening site reaches the break-even point of operation within one year if an average of two patients are screened per workday.
Collapse
Affiliation(s)
- Kira J. Szulborski
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Selin Gumustop
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Claudia C. Lasalle
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
| | - Kate Hughes
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Shiyoung Roh
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - David J. Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
| |
Collapse
|
|
7
|
Drinkwater JJ, Davis TME, Turner AW, Davis WA. Retinopathy prevalence, incidence and trajectories in type 2 diabetes: The Fremantle diabetes study phase II. Diabet Med 2023; 40:e15032. [PMID: 36537852 PMCID: PMC10947291 DOI: 10.1111/dme.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
AIMS To determine diabetic retinopathy (DR) prevalence, incidence, and whether distinct trajectories are associated with DR-complicating Type 2 diabetes. METHODS Retinal photographs from Fremantle Diabetes Study Phase II (FDS2) participants with Type 2 diabetes recruited in 2008-2011 and who attended biennial assessments for up to 6 years were graded as no DR, mild non-proliferative DR (NPDR), moderate NPDR or severe NPDR/proliferative DR. Baseline DR prevalence, and the cumulative incidence of moderate NPDR or worse in those without DR at baseline, were calculated. Group-based DR trajectory modelling was performed. Logistic regression determined independent associates of incident moderate NPDR or worse and trajectory group membership. RESULTS Of 1521 participants (mean age 65.6 years, 52.1% males, median diabetes duration 9.0 years; 98% of all FDS2 participants with Type 2 diabetes) with gradable baseline photographs, 563 (37.0%) had DR. During a median 6.1 years of follow-up, 23 (3.2%) without baseline DR developed at least moderate NPDR (crude incidence 6.1/1000 person-years) with HbA1c the sole independent predictor (odds ratio [95% CI]: 1.62 [1.30-2.02] per 1% [11 mmol/mol] increase). Trajectory analysis showed two distinct groups, those with baseline/persistent DR (20%) and those remaining DR free (80%). Longer diabetes duration, insulin use, higher mean HbA1c , higher mean systolic blood pressure and higher mean urinary albumin: creatinine ratio all increased the odds (p ≤ 0.014) of being in the persistent DR trajectory group. CONCLUSIONS The low incidence of at least moderate NPDR reflects the trajectory analysis. The currently recommended biennial retinal screening frequency for individuals without DR could potentially be extended.
Collapse
Affiliation(s)
- Jocelyn J. Drinkwater
- Medical SchoolThe University of Western Australia, Fremantle HospitalFremantleWestern AustraliaAustralia
| | - Timothy M. E. Davis
- Medical SchoolThe University of Western Australia, Fremantle HospitalFremantleWestern AustraliaAustralia
| | - Angus W. Turner
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute)The University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Wendy A. Davis
- Medical SchoolThe University of Western Australia, Fremantle HospitalFremantleWestern AustraliaAustralia
| |
Collapse
|
|
8
|
Hill S, Mullins P, Murphy R, Schmiedel O, Vaghefi E, Ramke J, Squirrell D. Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis. Asia Pac J Ophthalmol (Phila) 2021; 10:579-589. [PMID: 34905518 DOI: 10.1097/apo.0000000000000464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service. METHODS Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786). RESULTS Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all. CONCLUSIONS Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.
Collapse
Affiliation(s)
- Sophie Hill
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Peter Mullins
- Department of Statistics, University of Auckland, Faculty of Science, Science Centre 3030, Auckland 1010, New Zealand
| | - Rinki Murphy
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Department of Medicine, University of Auckland, Building 507, Grafton, Auckland 1023, New Zealand
| | - Ole Schmiedel
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
| | - Ehsan Vaghefi
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - David Squirrell
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
| |
Collapse
|
|
9
|
Kuo KH, Anjum S, Nguyen B, Marx JL, Roh S, Ramsey DJ. Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System. Clin Ophthalmol 2021; 15:3865-3875. [PMID: 34584400 PMCID: PMC8464359 DOI: 10.2147/opth.s330913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted a cross-sectional study to assess the utilization of a tele-ophthalmology screening program in a low-risk, suburban population of patients with diabetes. Methods A total of 214 diabetic patients without previously documented diabetic retinopathy (DR) underwent point-of-care non-mydriatic fundus photography through their primary care providers at five Beth Israel Lahey Health locations. The characteristics of the patients who received remote screening were compared with those patients who were eligible for screening but did not take part in the program. Time-driven activity-based costing (TDABC) was implemented to examine the cost of screening by tele-ophthalmology compared with in-person examinations. Results Tele-ophthalmology screening was more likely to be provided for patients who were younger (OR 0.985; 95% CI 0.973–0.997, p=0.016), who were obese (OR 2.04; 95% CI: 1.47–2.84, p=0.008), who had an HbA1c above 8.0% (OR 1.60; 95% CI: 1.13–2.26, p=0.031), or who had an eye examination in the past year (OR 5.55; 95% CI: 3.89–7.92, p<0.001). Those patients newly diagnosed with DR because of the program were more likely to have diabetic nephropathy (OR 7.79; 95% CI: 1.73–35.05, p=0.007). TDABC identified a health system cost-savings of between $8 and $29 per patient screened by tele-ophthalmology compared with the cost of in-person eye examinations. Conclusion Tele-ophthalmology presents an opportunity to reduce the costs of screening patients without prior evidence of DR, especially those who have completed a comprehensive eye examination within the prior year.
Collapse
Affiliation(s)
- Kristen H Kuo
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Sidrah Anjum
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
| | - Brian Nguyen
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.,Tufts University School of Dental Medicine, Boston, MA, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Jeffrey L Marx
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Shiyoung Roh
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - David J Ramsey
- Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|