Can Telemedicine Screening Detect Diabetic Retinopathy?

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About one in five patients were identified as having diabetic retinopathy through telemedicine screening.

Diabetic retinopathy was detected in about one in five people with diabetes who were screened for the condition using telemedicine, according to data published in JAMA Ophthalmology.

Diabetic retinopathy is the leading cause of new blindness in working-age adults, according to background information in the journal article. Routine dilated comprehensive eye exams are an important component of preventing and treating this complication, but the rate of eye examinations is low, especially among racial and ethnic minority populations.

Previous research indicates that diabetic retinopathy screening results that use nonmydriatic cameras for retinal imaging through telemedicine meet the standards of dilated photos. The nature of this type of screening, which precludes dilation or removes other barriers of access to care for patients with diabetes, may therefore be more convenient and beneficial.

To further investigate the potential of telemedicine screening for diabetic retinopathy, Cynthia Owsley, PhD, of the University of Alabama at Birmingham, and colleagues evaluated the use of screening with a nonmydriatic camera and telemedicine review at three urban clinics and one pharmacy.

The Innovative Network for Sight (INSIGHT) study included 1,894 people with type 1 or type 2 diabetes (mean age, 53 to 55 years). Of these, 31.7% of those screened were from Birmingham, Alabama, 32.1% from Miami, 26.7% from Philadelphia and 9.5% from Winston-Salem, North Carolina.

Mean age at diagnosis of diabetes was 44.5 years, and mean duration of diabetes was about 8 to 10 years in Birmingham, Miami and Philadelphia, and 14.6 years in Winston-Salem.

About half of the Birmingham participants reported having a dilated eye exam in the past, while at other sites, this percentage ranged from 25.5% to 32.4%. In Miami, 45.0% of participants reported having a dilated eye exam 2 or more years ago and 11.2% reported never having one.

Although the majority (88.0%) was racial/ethnic minorities, there were variations by site. In Birmingham, 84.3% were African-American; in Philadelphia and Winston-Salem, approximately 68% were African-American with a larger percentage of white participants than in Birmingham; and in Miami, 63.6% were Hispanic, Haitian or Cuban American and 33.9% were African-American.

Of all participants, telemedicine screening with the nonmydriatic camera identified diabetic retinopathy in at least one eye in 21.7%, according to the study data.

Results revealed that background diabetic retinopathy was the most common form of the condition, presenting in 94.1% of all participants with diabetic retinopathy. About half (44.2%) of those screened had other eye findings, 30.7% of which were cataracts.

The researchers also found that the presence of diabetic retinopathy did not differ significantly between white participants and the combined ethnic/racial minority groups (22.6% vs. 21.6%; P=.74).

Additionally, health insurance status (P=.21), time since last dilated eye exam (P=.44), smoking status (P=.40) and knowledge of HbA1c level (P=.82) were not associated with diabetic retinopathy.

Those with diabetic retinopathy, however, had a longer duration of diabetes than those without the eye condition (13.7 years vs. 8.8 years; P<.001).

“The rate of self-reported dilated eye care use in the past year was low for the overall sample (32.2%), suggesting that [diabetic retinopathy] screening in these settings could fulfill a critical role for patients with diabetes not routinely accessing annual dilated eye examination care,” the researchers wrote.


  1. Owsley C et al. JAMA Ophthalmol. 2014;doi:10.1001/jamaophthalmol.2014.4652.