Patients who had eye exams within the past year are 5 times more likely to choose remote screenings for diabetic retinopathy, which save health systems up to $29 per patient, research from Clinical Ophthalmology says.

The American Diabetes Association recommends patients with diabetes are regularly screened for diabetic retinopathy. Researchers believe theirs is the first study to analyze a teleophthalmology program in a low-risk, well-insured population.

In 2019 and 2020, primary care physicians (PCPs) offered patients with diabetes mellitus a remote retinal screening for diabetic retinopathy. Following screenings with nonmydriatic fundus photography (nFP) and color fundus photography, PCPs referred patients with suspect diabetic retinopathy to ophthalmologists.


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The 214 patients examined with teleophthalmology tended to be men (74% vs 63% χ 2 = 8.90, P =.003) with obesity (64% vs 54% OR 1.97 P =.008). They tended to have HbA1c of at least 8.0% (33% vs 23% OR 1.59 P =.005) and to have had an HbA1c measurement (91% vs 83% OR 1.97 P =.008) and a diabetic eye exam (73% vs 53% χ 2 = 50.553, P <.001) in the last year. Distance from the primary care clinic was linked with not having a primary care visit within the last year (OR 0.992 P =.006).

In multivariate analysis, the researchers found patients who had an eye exam in the past year were more than 5 times more likely to undergo the remote screening (73% vs 53% OR 5.55 P <.001). Patients who had obesity (64% vs 54% OR 2.04 P <.001) and those who had HbA1c of at least 8% (33% vs 23% OR 1.60 P =.008) were more likely to undergo remote screening. Patients who were older (mean 64.7 years vs 62.3 years OR 0.985 P =.016) were less likely to be screened remotely.

One of the 6 patients diagnosed with mild diabetic retinopathy through the screening was lost to follow-up. Seven of the 14 patients whose screening photographs were ungradable returned for an in-person evaluation. The rate of diabetic retinopathy (n=3) among the 7 was higher than the rate among the successfully screened population (χ2=11.10, P <.001).

Patients with known diabetic retinopathy had higher HbA1c (7.7% vs 7.2% P =.003). Patients diagnosed with diabetic retinopathy following the screenings were nearly 8 times more likely to have diabetic nephropathy (33% vs 6% OR 7.79 P =.007). Diagnosed nephropathy was about 3 times higher among patients with known diabetic retinopathy (OR 3.29 P <.001).

With time-driven activity-based costing (TDABC), the researchers estimated in-person dilated eye exams with an optometrist cost approximately $17.64 vs $41.53 with an ophthalmologist. Remote screenings cost about $3.40 for the labor of a medical assistant and $4.98 for a physician to grade the images. Positive (3%) or ungradable screening results (7%) prompt an in-person eye exam with an optometrist or ophthalmologist with a cost between $1.68 and $3.95, but they retain a cost-savings between $7.58 and $29.20 per patient.

Limitations of the study included lack of analysis of long-term benefits of teleophthalmology screening.

Reference

Kuo KH, Anjum S, Nguyen B, et al. Utilization of remote diabetic retinal screening in a suburban healthcare system. Clin Ophthalmol. 2021;15:3865-3875. doi: 10.2147/OPTH.S330913