Details:

Alternative Title:
JAMA Ophthalmol
Personal Author:
Mansberger, Steven L. ; Sheppler, Christina ; Barker, Gordon ; Gardiner, Stuart K. ; Demirel, Shaban ; ... More +
Mansberger, Steven L. ; Sheppler, Christina ; Barker, Gordon ; Gardiner, Stuart K. ; Demirel, Shaban ; Wooten, Kathleen ; Becker, Thomas M. ; Less -
Description:
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.
Subject:
[+]
Adult
Article
Diabetic Retinopathy
Female
Follow-Up Studies
Glycated Hemoglobin A
Humans
Macular Edema
Male
Mass Screening
Middle Aged
Photography
Physical Examination
Referral And Consultation
Telemedicine

Source:
JAMA Ophthalmol. 133(5):518-525. ;
Pubmed ID:
25741666
Pubmed Central ID:
PMC6023855
Document Type:
Journal Article ;
Funding:
K23 EY015501/EY/NEI NIH HHS/United States ; U48 DP000024/DP/NCCDPHP CDC HHS/United States ; U48 DP002673/DP/NCCDPHP CDC HHS/United States ; 3 K23 EY0155501-01/EY/NEI NIH HHS/United States ;
K23 EY015501/EY/NEI NIH HHS/United States ; U48 DP000024/DP/NCCDPHP CDC HHS/United States ; U48 DP002673/DP/NCCDPHP CDC HHS/United States ; 3 K23 EY0155501-01/EY/NEI NIH HHS/United States ; Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:de9505de242836c306225ada436c3ba66724a5f0f98cb02e1f77cf99e8f24250
File Type:

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