JAMA Ophthalmol

IMPORTANCE Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening exams. OBJECTIVE To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS From August 1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAIN OUTCOMES AND MEASURES 1) percentage of participants receiving annual diabetic retinopathy screening exams; 2) percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from Stage 0 (none) to Stage 4 (proliferative diabetic retinopathy); and 3) percentage of telemedicine participants who would require referral to an eye care provider for follow-up care using a cut-off of moderate diabetic retinopathy or worse, the presence of macular edema, or an ‘unable to determine’ result for either retinopathy or macular edema. RESULTS The telemedicine group was more likely to receive a diabetic retinopathy screening exam when compared to the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P < .001) and greater than 6-month through 18-month (53.0% [157/296] vs 33.2% [90/271]; 95% CI, 16.5%-23.1%; P < .001) time bins. After we offered telemedicine to both groups, we could not identify a difference between the groups in the percentage of diabetic retinopathy screening examinations. Diabetic retinopathy worsened by 2 stages or more in 35 (8.5%) of 409 participants (95% CI, 5.8%-11.2%) and improved by 2 stages or more in 5 (1.2%) of 409 participants (95% CI, 0.1%-2.3%) over the 4 year time period. The percentage of telemedicine participants requiring referral ranged from 19.2 (52/271) to 27.9% (58/208) during the study period. CONCLUSIONS AND RELEVANCE Telemedicine increased the percentage of diabetic retinopathy screening exams; most participants did not require referral to an eye care provider; and diabetic retinopathy levels were generally stable over the study period. This suggests that primary care clinics can use telemedicine to screen for diabetic retinopathy and monitor for disease worsening over a long period of time.

25741666

PMC6023855

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