Improving Access to Care: Teleretinal Screening for Diabetic Retinopathy in Six Los Angeles Urban Safety Net Clinics

Background: Diabetic retinopathy is a leading cause of blindness in US adults, affecting over 5.3 million Americans. However, severe vision loss from diabetic retinopathy can be reduced up to 94% by timely treatment with laser photocoagulation. In Los Angeles County, patients in the safety net at high risk for sight-threatening retinopathy experience wait times of up to 6-9 months for retinal examinations.

Methods: A teleretinal screening program was implemented in six safety net primary care clinics in South Los Angeles. Three ophthalmologists graded the images, providing diagnoses and recommendations for follow-up care. Retrospective data collection was simultaneously undertaken via chart review.

Results: Over 12 months, 1035 of 2732 patients (37.9%) screened needed a referral for specialty eye care and 260 (9.5%) were in need of possible treatment for diabetic retinopathy. Therefore, 1697 of 2732 (62.1%) had normal exams and were removed from the queue waiting for ophthalmology appointments, while those 9.5% with severe, treatable disease were flagged for expedited referral.

Conclusions: The results of this pilot study suggest that integrating teleretinal screening into the primary care visit can eliminate the need for separate visits to eye care providers for diabetics with normal fundus photos, preserving this scarce resource for those who need care and currently face long wait times. Primary care-based teleretinal screening could ultimately enable more timely access to treatment for those in need, resulting in a significant decrease in preventable blindness in this population.