Telemedicine helps diagnose eye problems in diabetic patients

Telemedicine can help physicians successfully diagnose eye conditions in patients with diabetes, according to a Veterans Health Administration (VHA) study published in JAMA Ophthalmology.

The VHA researchers evaluated the effect of a community-based diabetic teleretinal screening program on eye care use and resources. The retrospective medical record review looked at patients who underwent teleretinal screening at the Atlanta Veterans Affairs Medical Center from Oct. 1, 2008, through March 31, 2009—as well as those who were referred for an ophthalmic examination in the eye clinic.

Patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications and spectacle prescriptions all were examined as part of the study.

Of the diagnoses, the most common were:

• nonmacular diabetic retinopathy (43.2 percent);
• nerve-related disease (30.8 percent);
• lens or media opacity (19.1 percent);
• age-related macular degeneration (12.9 percent); and
• diabetic macular edema (5.6 percent).

The percentage of agreement among these five visually significant diagnoses was 90.4 percent, with a total sensitivity of 73.6 percent. Of the procedures, diabetic macular edema required the greatest number of ophthalmology clinic visits, diagnostic tests, and surgical procedures. Using Medicare cost data estimates, the mean cost incurred during a 2-year period per patient seen in the eye clinic was approximately $1,000.

“Although a teleretinal screening program can be accurate and sensitive for multiple visually significant diagnoses, measurable resource burdens should be anticipated to adequately prepare for the associated increase in clinical care,” concluded the authors.