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Improving Diabetic Retinopathy Screening Ratios Using Telemedicine-Based Digital Retinal Imaging Technology

The Vine Hill Study

¹ Vanderbilt University School of Nursing, Nashville, Tennessee
² Vanderbilt Ophthalmic Imaging Center, Vanderbilt Eye Institute, Nashville, Tennessee
³ University of Arizona College of Nursing, Tucson, Arizona
⁴ Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
⁵ Vanderbilt University School of Medicine, Nashville, Tennessee

Address correspondence and reprint requests to Cathy R. Taylor, DrPH, MSN, RN, Vanderbilt University School of Nursing, 461 21st Ave. South, 316 Godchaux Hall, Nashville, TN 37240. E-mail: cathy.taylor{at}vanderbilt.edu

OBJECTIVE—To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic.

RESEARCH DESIGN AND METHODS—This retrospective cohort study included all diabetic patients aged 18 years (n = 495) seen at Vine Hill Community Clinic between 1 September 2003 and 31 August 2004. Patients were offered ophthalmology referral or digital screening. Patients choosing referral received the next available (within 3 months) appointment at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit.

RESULTS—Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity (² = 7.9, P < 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%).

CONCLUSIONS—Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need.

Abbreviations: DR, diabetic retinopathy • VHCC, Vine Hill Community Clinic • VOIC, Vanderbilt Opthalmic Imaging Center

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