To evaluate the use of telemedicine retinal screening in Italy and to identify potential elements of implementation of this system.
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.
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.
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
AuthorsMassimo Porta, Francesco Boscia, Paolo Lanzetta, Edoardo Mannucci, Ugo Menchini, Francesca Simonelli
- • Accepted on 05/11/2016
- • Available online on 21/11/2016
- • Published in print on 10/03/2017
This article is available as full text PDF.
- Porta, Massimo [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
- Boscia, Francesco [PubMed] [Google Scholar] 2
- Lanzetta, Paolo [PubMed] [Google Scholar] 3
- Mannucci, Edoardo [PubMed] [Google Scholar] 4
- Menchini, Ugo [PubMed] [Google Scholar] 5
- Simonelli, Francesca [PubMed] [Google Scholar] 6
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