Introduction: Diabetic retinopathy is the leading cause of blindness in the US. Teleophthalmology or store-and-forward camera-based eye screening and pop-up eye clinic that allows comprehensive eye examination in remote locations are two methods for improving screening for diabetic retinopathy in underserved neighborhoods. We used a qualitative and quantitative approach to identify facilitators and barriers of implementing teleophthalmology and pop-up eye clinics for diabetic retinopathy screening in a rural primary care setting.

Methods: Quantitative analysis involved 885 diabetic patients seen in two rural clinics who were characterized into four groups: patients participating in pop-up clinic dilated eye exams (n=52), teleophthalmology (n=39), in-person dilated eye exams at the eye doctor (n=586), and no recent eye exam (n=208). Qualitative analysis included five patient interviews from each of the four groups (n=20), and 14 staff interviews from primary care and ophthalmology.

Results: Of the four groups, patients in the teleophthalmology and pop-up eye clinic groups had the highest rates of unmet transportation needs (7.4%), housing instability (14.3%) and food insecurity (15%). More eye pathology including diabetic retinopathy (21% versus 7.7%) and vision problems (48% versus 22%) were detected in the pop-up eye clinic than in teleophthalmology but teleophthalmology was seen as quicker and more convenient. The main barrier to teleophthalmology was staff training while scheduling barriers led to underutilization of the pop-up eye clinic.

Conclusion: Complementing teleophthalmology screening with pop-up eye clinic comprehensive eye exam for those who screen positive for an eye disease may improve access to care for screening for diabetic retinopathy.