A Pilot Study of Dissemination of Teleretinal Imaging To Limit Disparities in Diabetic Retinopathy in Rural North Carolina
Abstract Number: 667-P
Authors: KATRINA E. DONAHUE, PAUL BRAY, DOYLE M. CUMMINGS, CHRISTINA OLLIS, MADELINE MITCHELL, RICHARD DAVIS
Institutions: Chapel Hill, NC, Greenville, NC, Windsor, NC
Results: Early detection and treatment of Diabetic Retinopathy (DR) can significantly reduce severe vision loss. However DR screening rates remain low, especially in areas where access to an ophthalmology specialist is difficult. Here we examine the feasibility of teleretinal imaging via point of care screening for DR amongst population groups with type 2 diabetes, and the difference between the primary care based evaluation of digital retinal photos compared to that of an ophthalmologist.
Teleretinal imaging was placed in a rural primary care practice. Patients with diabetes were offered a point of care digital imaging exam at their office visit. A licensed practical nurse (LPN) trained by an ophthalmologist screened the retinal images for DR based on the International Classification of Diabetic Retinopathy and this reading was in parallel to a remote ophthalmologist.
Of 87 patients offered screening, 82 consented (94.2%) and seventy-seven (88.5%) underwent imaging. The eyes of 5 patients could not be dilated. The average age was 57.2 years (range: 26-86); 53.2% were female; 71.4% were African American. Of the patients evaluated, 23.4% had abnormal retinal images requiring ophthalmologic referral, and over one-third of abnormal images showed moderate to severe retinopathy. Agreement in readings between the LPN and ophthalmologist reader was assessed using weighted kappa. The weighted kappa for the left eye ratings was .90 and .93 for the right eye. Two patients (2.4%) rated as having mild NPDR by the LPN were assessed by the ophthalmologist as having no retinopathy. No patient having some degree of retinopathy was missed by the LPN.
Retinal assessments within the primary care setting appear acceptable to patients and successful with the majority of those consented. A large number (23.4%) of patients evaluated had retinal disease. There was excellent agreement in readings between the trained LPN and those of the ophthalmologist. This study shows the feasibility of point of care screening in identification of patients from rural populations at significant risk for DR.