Importance

The use of a non-mydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes from minority populations with low eye care utilization.

Objective

To examine the rate and types of DR identified through a telemedicine screening program using a non-mydriatic camera, as well as the rate of other ocular findings.

Design

Cross-sectional.

Setting

Four urban clinic or pharmacy settings in the United States serving predominantly minority and uninsured persons with diabetes.

Participants

Persons age ≥ 18 years old who have type 1 or 2 diabetes and present to the community-based settings.

Main Outcome Measure

Percentage of DR detection including type of DR, and percentage of detection of other ocular findings.

Results

A total of 1,894 persons participated in the screening program across sites, with 21.7% having DR in at least one eye. The most common type of DR by far was background DR, which was present in 94.1% of all participants with DR. Almost half of those screened had ocular findings other than DR with 30% of other findings being cataract.

Conclusions and Relevance

In a DR telemedicine screening program in urban clinic/pharmacy settings in the US serving predominantly minority populations, 1 in 5 persons with diabetes screened positive for DR. The vast majority of DR was background indicating high public health potential for intervention in DR’s earliest phases when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be under appreciated.