Screening for diabetic retinopathy in rural areas: The potential of telemedicine

Diabetic retinopathy is a common cause of blindness, and screening can iden tify the disease at an earlier, more treatable stage. However, rural indivi duals with diabetes may have limited access to needed eye care. The objecti ve of this project was to demonstrate the feasibility of a diabetic retinop athy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primar y care and public health locations throughout seven predominantly rural cou nties in eastern North Carolina. Images of each fundus were obtained and se nt to a retinal specialist. The retinal specialist reviewed each image, rec orded image quality, diagnosed eye disease and made recommendations for sub sequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 p ercent reported that they were very comfortable or comfortable with the cam era. Eighty-five percent of images were rated as good or fair by the retina l specialist. The retinal specialist also reported being very certain or ce rtain of the diagnosis in 84 percent of cases. Image quality correlated hig hly with the certainty of diagnosis (Spearman's rank order correlation coef ficient=0.79; P (0.001). The average time since tile previous examination b y an eye cave specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most c ommon of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were move likely to have retinopathy. Digital imaging is a feasible screening mo dality in rural areas, may improve access to eye care, and may improve comp liance with care guidelines for individuals with diabetes mellitus.