Multi-center study of diabetes eye screening in community settings in the United States

We examined the feasibility of non-invasive, non-mydriatic fundus imaging in five community-based clinic and pharmacy settings to screen for diabetic retinopathy (DR) among underserved adults with diabetes (DM). DR screening consisted of non-mydriatic fundus imaging by trained technicians. After transmission, images were graded by the Wills Eye Telemedicine Reading Center using a system based on the UK National Health Service's classification system for DR. Patients with positive findings were recommended to seek comprehensive eye care in a timely fashion, if they were not already receiving eye care; guidance was provided to patients who needed assistance in accessing follow-up eye care. To date >1,500 adults were screened (63% Black, 19% Hispanic, 11% White, 7% other). Self-reported time since DM diagnosis averaged 9 years. 43% reported ≥2 years since their most recent dilated exam. 22% had DR in at least one eye, most of which was background DR (93%). Likelihood of DR increased with diabetes duration (p<.0001). DR prevalence was higher in patients seen in clinic than in pharmacy settings (24% vs. 16%, p=.0004), regardless of race/ethnicity. DR prevalence was unrelated to recency of self-reported dilated eye exam. 12% of images were deemed unreadable by the reading center, which was unrelated to cataract presence. In conclusion, DR was detected in about 1 in 4 patients with DM screened in these community settings. Telemedicine screening at the primary care clinic or pharmacy represents a potentially useful model to improve DR detection and the prevention of vision loss in underserved populations.