245344 Comparative effectiveness of telemedicine to detect diabetic retinopathy in American Indians and Alaska Natives

Wednesday, November 2, 2011: 9:00 AM

Steven Mansberger, MD, MPH , Legacy Health System, Discoveries in Sight/Devers Eye Institute, Portland, OR
Kenneth Gleitsmann, MD , Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR
Stuart Gardiner, MA, CASM, PhD , Legacy Health System, Discoveries in Sight/Devers Eye Institute, Portland, OR
Christina Sheppler, PhD , Legacy Health System, Discoveries in Sight/Devers Eye Institute, Portland, OR
Thomas Becker, MD, PhD , Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR
BACKGROUND: Diabetic retinopathy is the leading cause of new cases of blindness among U.S. adults aged 20–74. Both diabetes and diabetes-related blindness disproportionately affect American Indians and Alaska Natives (AI/AN). Early detection and treatment have been shown to prevent vision loss, but multiple barriers to receiving annual eye exams exist in the AI/AN population, including limited access to eye care providers in rural areas. METHODS: The researchers partnered with two tribal health clinics in Oregon and Kansas to focus on screening for diabetic retinopathy. Participants were randomly assigned to either telemedicine (using digital images of the retina captured with a non-mydriatic camera) or traditional surveillance (annual eye exams in an eye care provider's office). Experts used a validated scale to grade diabetic retinopathy from Stage 0 (no retinopathy) to Stage 5 (proliferative diabetic retinopathy). RESULTS: The proportion of those that received a screening exam within one year of enrollment was higher in the telemedicine group than the traditional surveillance group (94% vs. 44%, p<0.001). The prevalence of diabetic retinopathy at baseline was 25%, with severity graded as “none” in 75%, “mild non-proliferative” in 15%, “moderate non-proliferative” in 7%, “severe non-proliferative” in 1%, “very severe non-proliferative” in 0%, and “proliferative” in 2%. Diabetic retinopathy was associated with higher mean systolic blood pressure (p=0.013), non-white primary ethnicity (p=0.019), higher mean HgA1c (p<0.001), and longer duration of diabetes (p<0.001). CONCLUSION: Data from this research may contribute to changes in national and state guidelines in the delivery of diabetic eye exams.

Learning Areas:
Public health or related research

Learning Objectives:
1. Discuss the importance of screening for retinopathy in diabetic patients. 2. Evaluate whether telemedicine has potential for increasing the proportion of eye exams in underserved populations.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Associate Scientist and the Director of Glaucoma Services and Ophthalmic Clinical Trials for the Devers Eye Institute in Portland, Oregon. I hold appointments at Oregon Health & Science University as a Clinical Associate Professor of Ophthalmology and Public Health and Preventive Medicine. I have research grant support from the National Eye Institute and the Centers for Disease Control and Prevention, and I have authored over 100 journal articles, book chapters, and abstracts.
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.