Integration of Ocular Telemedicine for Diabetic Retinopathy in a Community Health Center

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Integration of Ocular Telemedicine for Diabetic
Retinopathy in a Community Health Center

• Sharon Eagan, OD
• Lloyd M. Aiello, MD Paula DeVitt, RN
• Greg Lopez Michael Seligson, MD
• Kristen Hock, BS Nigel Timothy, MDJerry
  Cavallerano, OD, PhD
• Joslin Vision Network Reader Team

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Background

• La Familia Medical Center (LFMC)nonprofit,
  nonsectarian community health center in Santa Fe,
  NM
• LFMC provides comprehensive medical, dental, and
  health education services with special emphasis
  on underserved persons.
• LFMC incorporated the Joslin Vision Network
  Diabetes Eye Care Program (JVN) as part of its
  diabetes service in April 2005

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Methods

• Certified JVN imagers acquire retinal images
  without pupil dilation according to JVN protocol
  of LFMC patients with diabetes mellitus (DM).
• Images are electronically transmitted to Joslin
  Diabetes Center for grading by certified readers
• Treatment plan recommendation is returned
  electronically to the patient care coordinator at
  LFMC.

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JVN Image Fields


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No or Minimal DRor Ungradable Images

• Periodic repeat JVN imaging
• Expanded evaluation provided by local Lions Club
  (visual acuity testing, intraocular pressure
  reading, fundus evaluation)
• Referral for comprehensive eye exam.

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Advanced Diabetic RetinopathyModerate or more
advanced nonproliferative DR, proliferative DR,
diabetic macular edema, or other nondiabetic
related eye conditions

• Comprehensive eye examination
• Retinal specialist consult

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Patient Demographics
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Results-1

• 344 patients imaged (687 eyes)
• 223 patients(64.8) reported no history of eye
  examination within the previous 12 months
• 40 patients (11.6) had no previous history of
  eye examination

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Results687 EyesLevel of Diabetic Retinopathy

• 464 (67.5) had no DR
• 124 (18.0) had mild-moderate NPDR
• 7 (1.0) had severe-very severe NPDR
• 12 (1.7) had PDR
• 10 (1.5) had quiescent PDR
• 19 eyes (2.8) had DME (13 CSME)
• 70 eyes (10.2) ungradable for level of DR

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Results-2 (n687 eyes)
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Results-3

• 81 (11.8) eyes had at least moderate NPDR and/
  or DME
• 99 (18.5) of the 535 eyes with no diabetic eye
  disease (no or mild NPDR and no DME) were
  referred for nondiabetes-related eye disease
• 20 (28.6) of the 70 eyes with images ungradable
  for level of DR had referable cataract

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Nondiabetes Related Findings
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Discussion-1

• JVN nonmydriatic retinal imaging program
  successfully integrated eye care into the overall
  diabetes care at LFMC
• JVN provided access to eye care for 81 eyes
  (11.8) with significant diabetic eye disease
  that might otherwise have not received timely and
  appropriate follow up and treatment
• JVN identified 99 eyes with nondiabetic medical
  or ocular conditions.

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Discussion-2

• JVN accessed a significant number of patients who
  had no eye exam within the past 12 months
• JVN reinforced patient education as to the
  importance of timely and appropriate eye
  examinations and maintaining optimal glycemic
  control

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Summary and Conclusion

• The JVN was successfully integrated into a
  community health center providing care to
  underserved persons and added on-site diabetes
  eye care to comprehensive diabetes care.

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Thank You