Timely screening for diabetic retinopathy and diabetic macular edema is crucial to prevent blindness, but patient compliance with traditional screening methods remains low.
“Only slightly more than half of patients in the United States with diabetes mellitus (DM) receive an annual screening examination,” investigators explained in a report published in Ophthalmology. “The reasons behind this relatively poor compliance are multifactorial, but include limited access to health care, socioeconomic constraints, lack of patient awareness, and social determinants of health.”
As the number of individuals with diabetes continues to grow at a rate far exceeding the increase in the global ophthalmologist workforce—by more than tenfold—it becomes increasingly crucial to develop efficient screening methods capable of reaching a large patient population, noted investigators. Teleretinal screening (TS) offers a promising solution by enhancing access to ophthalmic care and potentially boosting compliance with diabetic retinopathy (DR) screening.
While TS showed acceptable sensitivity and good specificity in detecting DR, its performance was less robust in identifying diabetic macular edema. Moderate to good agreement between TS and reference-standard DR grading was observed across the reviewed studies.
In one reviewed study, TS had a sensitivity of 78% and a specificity of 86% in detecting referable DR when compared to the reference standard, which included dilated fundus examinations and 7-standard field ETDRS photographs. Another study found that TS images were more likely to interpret a higher level of DR severity compared to traditional methods, which is preferable in screening programs to avoid underdiagnosing.
Another study found 94.6% of patients in the TS group received DR screening within 6 months, compared to only 43.9% in the traditional surveillance group. Another showed that the implementation of TS increased screening rates from 25.6% to 40.4%. Overall, TS was found to double the screening compliance rates in certain populations, particularly in underserved areas where access to ophthalmic care is limited.
High satisfaction with TS was also reported in several studies. Patients appreciated the convenience and reduced wait times associated with TS, while providers expressed satisfaction when TS improved access to care.
An analysis of a national program in Singapore found that TS incurred lower costs while generating similar quality-adjusted life-years compared to traditional screening.
Given the effectiveness demonstrated by TS in this review, the researchers suggested that future “studies should focus on identifying the ideal approach to TS that will maximize accuracy and minimize costs.” They described advances in camera technology, integration of AI for reading images, and incorporation of imaging modalities such as optical coherence tomography that could contribute to TS in the future.
A full list of author disclosures can be found in the published research.
