Diabetic retinopathy is one of the leading causes of vision loss in the United States and affects roughly 35% of diabetic patients. Although effective treatments supported by large clinical trials exist, many patients lose their vision because of late diagnosis and delayed treatment.
Traditional screening for eye disease is available, and typically requires examinations by eye care specialists through dilated pupils. However, fewer than 50% of patients at risk receive such screening.
A study published in JAMA Ophthalmology on May 16, 2019, by Duke Eye Center researcher Majda Hadziahmetovic, MD et al., under the guidance of Scott Cousins, MD showed that we might be able to improve early detection of this sight-threatening disease. The authors propose the remote diagnosis model instead of the traditional teleophthalmology approach. The traditional method takes color fundus photography (CFP) of dilated pupils and is performed by expert photographers with expensive equipment in a dedicated bricks-and-mortar imaging center or a mobile van. Remote diagnosis is the use of CFP and optical coherence tomography (OCT) on non-dilated pupils and is performed by non-expert imagers using less expensive equipment permanently located at the point of service (eg, primary care clinic). This approach potentially offers patient convenience and a high rate of patient capture.
In this study, the team evaluated the feasibility of remote retinal imaging as a diagnostic tool for identifying referable macular degeneration. The approach was tested on 159 patients in the facilities with high rates of diabetic retinopathy and age-related macular degeneration, and used retinal imaging device (iFusion by Optuvue) appeared to be equivalent to a gold standard examination (dilated exam by a retina specialist). Good operational characteristics found in this study suggest the feasibility of using this model to screen and refer patients to a retinal specialist. Also, it was confirmed that the combination of CFP and OCT in this setting was non-inferior in macular degeneration screening compared with either OCT or CFP alone.
These results show that office-based ocular imaging at the primary care point of service is accessible, efficient, low-cost, high-quality and improves patient satisfaction for the screening of diabetic retinopathy.
This study was done in the environment with relatively high disease prevalence, thus the team has to test this concept in a ’real world’ setting. The field testing in Duke Primary Care offices has already been initiated, and its results are soon to be seen.