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Systematic screening of Retinopathy in Diabetes (REaD project): an Italian implementation campaign

Abstract

Purpose

To evaluate the use of telemedicine retinal screening in Italy and to identify potential elements of implementation of this system.

Methods

Patients with either new-onset diabetes or no ophthalmologic visit over the previous 2 years and attending 33 referral diabetic centers between mid-April 2013 and mid December 2015 were screened. Two partially overlapping nonstereoscopic 45° digital color images were captured from each eye using a fully automated nonmydriatic digital fundus camera. Factors limiting the assessment of retinopathy were explored.

Results

Out of 24,473 eligible individuals, 22,466 had complete data. Among them, good-quality images enabling appropriate evaluation of at least one eye were obtained from 19,712 patients (both eyes, n = 18,887). Although nonmydriatic retinographs were provided, 39% of patients were evaluated using mydriasis. The rate of low-quality images in each center was inversely associated with the number of patients assessed. This was more evident for screening in mydriasis: adjusted odds ratio (OR) 0.79 (95% confidence interval (CI) 0.76-0.82) (p<0.001) vs 0.96 (95% CI 0.94-0.97) (p<0.001). Finally, both the number of patients assessed and use of mydriasis were inversely related to the presence of diabetic retinopathy (DR): adjusted OR 0.93 (95% CI 0.92-0.93) (p<0.001) and 0.88 (95% CI 0.82-0.96) (p<0.001), respectively.

Conclusions

This program confirmed a role for teleophthalmology in the systematic screening of DR and provided important suggestions to improve the system deployed. A high level of training is required for operators to optimize imaging. The role of mydriasis should be evaluated further.

Eur J Ophthalmol 2017; 27(2): 179 - 184

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ejo.5000912

Authors

Massimo Porta, Francesco Boscia, Paolo Lanzetta, Edoardo Mannucci, Ugo Menchini, Francesca Simonelli

Article History

Disclosures

Financial support: The REaD Project was an ECM Programme conducted in Italy and supported by an unrestricted grant of Novartis Farma SpA, Italy.
Conflict of interest: Massimo Porta, MD, reports having received consultancy and speaker honoraria from Novartis, Sanofi, Astra Zeneca, Takeda, Abbott, and Roche Diagnostics. Francesco Boscia, MD, has served as a consultant and a lecturer for Alcon, Bayer, and Novartis and has served as a consultant for Pfenex and a lecturer for Allergan. Paolo Lanzetta, MD, reports having received consultancy and speaker honoraria and investigator grants from Novartis and Centervue. Edoardo Mannucci, MD, has received speaking and/or consultancy fees and/or research grants from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novartis, Novo Nordisk, Sanofi, and Takeda. Ugo Menchini, MD, has no conflicts of interest that are directly relevant to the content of this paper. Francesca Simonelli, MD, has served as an advisory board member for Novartis. The authors have no proprietary or commercial interest regarding any of the products mentioned.

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Authors

Affiliations

  • Department of Medical Sciences, University of Turin, Turin - Italy
  • Eye Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari - Italy
  • Department of Medical and Biological Sciences, Ophthalmology, University of Udine, Udine - Italy
  • Diabetes Unit, Careggi Hospital, Florence - Italy
  • Careggi University Hospital, University of Florence, Florence - Italy
  • Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples - Italy

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