20 May Teleretinal Imaging Improves Detection of Diabetic Retinopathy in Low Resource Setting
MedicalResearch.com Interview with:
Executive Director – LAICO &
Director – Opeations
Aravind Eye Care System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Diabetic Retinopathy (DR) is a visual consequence of diabetes and various other studies have reported that in India, 10% to 30% of adults with diabetes have DR, with higher rates found in older people and urban areas. Undetected DR leads to vision loss and eventually blindness. Thus early identification of DR is critical to initiate appropriate treatment to reduce the rate of vision loss.
Conventional approaches of requesting diabetologists to refer patients with diabetes to an ophthalmologist has been ineffective due to compliance issues, both by the diabetologists and the patients. Similarly screening through outreach eye camps have not been found to be effective in India and other developing countries owing to inadequate eye care resources. Teleretinal screening for Diabetic Retinopathy is increasingly being used in India. Evidence from randomized clinical trials on the benefits of teleretinal screening is limited. Whatever evidence is there are from high income countries, which often have little relevance to developing countries.
MedicalResearch.com: What should readers take away from your report?
Response: In this cluster randomized clinical trial of 801 patients with diabetes, proportionately more patients in the teleretinal arm of the study attended the eye hospital for a detailed retinal examination compared with the control group. The teleretinal arm also had a higher levels of patients detected with diabetic retinopathy. This confirms the potential benefit of a targeted referral approach using teleretinal screening to detect patients with Diabetic Retinopathy. This approach helps diabetologists and physicians managing patients with diabetes to better manage the condition and holistically.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We were unable to confirm the DR status of those who did not attended the hospital based eye examination. Our findings requires further confirmation in a large population based trial using different strategies of enhancing adherence to referral for eye examination.
Joseph S, Kim R, Ravindran RD, Fletcher AE, Ravilla TD. Effectiveness of Teleretinal Imaging–Based Hospital Referral Compared With Universal Referral in Identifying Diabetic Retinopathy: A Cluster Randomized Clinical Trial. JAMA Ophthalmol. Published online May 09, 2019. doi:10.1001/jamaophthalmol.2019.1070
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