Telescreening of Diabetic Retinopathy

We run a busy endocrinology program and diabetes clinic, with an average of 1,000 to 1,200 patient visits a month. Around 60 to 65% of these patients live with diabetes, and a significant number of these patients have micro- and macrovascular complications. While tools and resources are available to screen and diagnose most of these complications, timely diagnosis of retinal involvement has always been a challenge. One reason for this has been the need for a separate visit to an ophthalmologist's office. This inconvenience led to a poor eye care seeking behavior, resulted in suboptimal clinical outcomes. Such a challenge is not unique to us, and it has been reported by clinicians and diabetes care providers from across the world.[1] [2]

In an effort to overcome this barrier, we assessed and appraised various solutions for retinal examinations during a diabetes clinic visit. One of these is IRIS (Intelligent Retinal Imaging Systems, Pensacola, Florida, United States). Using this technology, a diabetes care provider is able to perform retinal examination during routine diabetes care visit. Retinal imaging can be performed by a trained paraclinical staff. Retinal pictures are populated in the electronic medical record, transmitted to designated ophthalmologists in Boston, and reported by them within 24 hours.

From May of 2016 onward, we have performed 800 to 1000 scans yearly, using two cameras, one in our office and one in a primary care clinic. The following data show a high-level overview of the current status of the IRIS Diabetic Retinal Examination program for St Vincent Endocrinology, Evansville, for the month of October 2018 ([Fig. 1]):

Fig. 1 Overview of the current status of the IRIS Diabetic Retinal Examination program for St Vincent Endocrinology.

Number of patients tested 59

Number of patients with pathology 18

Number of patients with diabetic retinopathy 14

Percent of patients with pathology 31%

Percent of not readable photographs 0%

• References

• 1 Cavan D, Makaroff L, da Rocha FernandesJ. et al. The Diabetic Retinopathy Barometer Study: global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract 2017; 129: 16-24
• 2 Thomas RL, Dunstan FD, Luzio SD. et al. Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. Br J Ophthalmol 2015; 99 (01) 64-68
• 3 Philip S, Ahmed A, Prescott G. et al. Can automated analysis of sequential retinal images of people attending diabetic retinopathy screening predict future referral to ophthalmology?. Physica Medica. Eur J Med Physics 2016; 32: 275
• 4 Mansberger SL, Sheppler C, Barker G. et al. Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: a randomized clinical trial. JAMA Ophthalmol 2015; 133 (05) 518-525
• 5 Naik S, Wykoff CC, Ou WC, Stevenson J, Gupta S, Shah AR. Identification of factors to increase efficacy of telemedicine screening for diabetic retinopathy in endocrinology practices using the Intelligent Retinal Imaging System (IRIS) platform. Diabetes Res Clin Pract 2018; 140: 265-270