Telemedicine May Help Promote Eye Exam Access for People With Diabetes

A nationwide telemedicine diabetic screening program could help prevent diabetic retinopathy, the top cause of new-onset blindness in the United States.

Researchers studied older adults with diabetes to see if rates of diabetic retinopathy would decrease among participants in a telemedicine screening program. Nita G. Valikodath, BA, MS, of the University of Michigan, and colleagues recruited patients from the Duke University Medical Center and the Durham Veterans Affairs primary care and endocrine clinics for the telemedicine study. The study was published in Telemedicine and e-Health.

Only 3% of the 97 patients surveyed had heard of telemedicine, but once it was explained, 69% believed telemedicine could be more convenient than traditional exams with a specialist. The study found that demographic factors were not associated with the outcomes. Patients who believed that telemedicine would be more convenient than a routine eye exam, or who had other health concerns that made it harder for them to get to a physician’s office, were more willing to participate in the telemedicine examination. However, patients who had lived with diabetes for a number of years or who had a good relationship with their primary care physician were less interested in participating in the telemedicine exams.

“Patients with long-standing disease are less likely to trust a new, less personal delivery model,” explained senior study author Maria Woodward, MD, assistant professor of ophthalmology at the University of Michigan’s Kellogg Eye Center and a member of the Institute for Healthcare Policy & Innovation at the University. She said the convenience of telemedicine was the factor with the highest impact on the patient’s decision to participate in telemedicine examinations. “Willingness to participate in telemedicine for diabetic retinopathy screening reflects how patients perceived convenience, the patient-physician relationship, and their own health.”

The telemedicine screening works as follows: retinal photographs of both eyes are taken at the primary care physician’s office using a no-dilation retina camera. The images are sent over a secure, cloud-based network to an ophthalmologist, who sends a report back to the primary care physician. Based on the ophthalmologist’s findings, the patient is either scheduled for more photographs in the clinic or referred to an ophthalmologist.

Currently, fewer than 65% of US adults with diabetes undergo screening for diabetic retinopathy, for which early detection and treatment are key to preventing blindness. In underserved populations, rates can drop as low as 10% or 20%. After the implementation of a nationwide telemedicine diabetic screening program in England and Wales, diabetic retinopathy is no longer a leading cause of blindness there.

The study authors concluded that it is critical to understand the attitudes of people with diabetes, where telemedicine shows promise for disease management and end-organ damage prevention. Receptive patients focus on convenience, whereas unreceptive patients strongly value their patient-physician relationship or have long-standing diabetes, and they recommend that telemedicine monitoring be designed for people who are in need and receptive to telemedicine.