223334 Using Telemedicine to Detect Diabetic Retinopathy in American Indian/Alaska Natives and Other Ethnicities

Sunday, November 7, 2010

Steven Mansberger, MD, MPH , Center for Healthy Communities, Department of Ophthalmology, Department of Public Health and Preventive Medicine, Devers Eye Institute/Oregon Health & Science University, Portland, OR
Thomas Becker, MD PhD , Center for Healthy Communities, Dept. of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
Methods: We randomly selected diabetic patients to participate in a store-and-forward telemedicine program using non-mydriatic cameras (Camera group). We performed retinal photography at least once per year and used the International Diabetic Retinopathy scale to stage DR from Stage 1 (mild NPDR) to Stage 5 (proliferative DR). Diabetic educators and providers also encouraged the participants to have an annual eye exam with an eye care provider.

Results: We randomized 547 participants: 285 (52%) to the Camera group and 262 (48%) to the Control group. The Camera group had images evaluated in 224 (79%), with 14 (6.3%) having images that were unreviewable. Only 105 (40%) of the Provider group participants had an eye exam. The initial evaluation in the Camera group (more severe eye) showed 32 (14.2%) had mild NPDR; 7 (3.1%) were moderate; and 2 (0.9%) had very severe NPDR. Of those with images in the Camera group, DR worsened (> 1 stage) in 7 persons (3.0%); DR improved (< 1 stage) in 3 persons (1.3%); and stayed the same in 36 persons (16.1%).

Conclusion: Retinal imaging using a non-mydriatic camera increases the proportion of diabetics who obtain screening eye exams. Most diabetics in this sample did not have levels of diabetic retinopathy that required ophthalmic intervention.

Learning Areas:
Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
To determine the level of diabetic retinopathy (DR), the need for ophthalmology referral, and proportion of progressive diabetic retinopathy in underserved rural and urban populations of American Indian/Alaska Natives (AI/AN) and other ethnicities using a telemedicine protocol.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-investigator.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.