Online Program

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

Tuesday, November 5, 2013 : 11:15 a.m. - 11:30 a.m.

Gerald McGwin, MS, PhD, Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
David Friedman, MD, MPh, PhD, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore
Julia A. Haller, MD, Ophthalmologist-in-Chief, Wills Eye Institute, Philadelphia, PA
David J. Lee, PhD, Epidemiology & Public Health, University of Miami, Miami, FL
Jinan B. Saaddine, MD, MPH, National Vision Program, Centers for Disease Control and Prevention, Atlanta, GA
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.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Implementation of health education strategies, interventions and programs

Learning Objectives:
Demonstrate feasibility of using non-invasive, non-mydriatic fundus imaging in community-based clinic and pharmacy settings to screen for diabetic retinopathy among persons with diabetes from underserved populations.

Keyword(s): Vision Care, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 15 years experience in the epidemiology of eye diseases and vision impairment. I have served as principal or co-investigator on multiple federally funded and privately funded grants and contracts on this topic. I have numerous peer review publications on the topic.
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.