Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program

Retina. 2003 Apr;23(2):215-23. doi: 10.1097/00006982-200304000-00013.


Purpose: To incorporate a nonmydriatic, digital-video retinal imaging system into a Diabetes Outpatient Intensive Treatment Program and to evaluate the system's ability to assess diabetic retinopathy (DR), determine follow-up, and appropriately refer to retinal specialist ophthalmologists.

Methods: Fundus images were obtained according to Joslin Vision Network (JVN) protocol and evaluated by certified JVN readers. Patients with significant retinal disease underwent evaluation by retinal specialists.

Results: A total of 268 (51.0%) of 525 imaged patients had comprehensive eye examination by a retinal specialist owing to referable JVN-assessed clinical level of DR, nondiabetic ocular disease, ungradeable images, last eye examination >/=12 months prior, or patient request for examination. JVN diagnosis of a clinical level of DR agreed exactly with clinical findings in 388 eyes (72.5%) or within one level in 478 eyes (89.3%). JVN referral based on most severe diagnosis in either eye matched retinal specialist-recommended follow-up in 248/268 of patients (92.5%). A total of 136/525 (25.9%) of JVN patients had nondiabetic ocular abnormalities requiring referral.

Conclusions: Recommended follow-up from JVN imaging compared favorably to clinical examination by a retinal specialist. Nondiabetic ocular pathology was identified. JVN assessment of DR level compares favorably to clinical practice, potentially improving access to eye care and enhancing diabetes management.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetic Retinopathy / classification
  • Diabetic Retinopathy / pathology*
  • Diagnosis, Differential
  • Diagnostic Techniques, Ophthalmological / standards*
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted*
  • Information Services*
  • Male
  • Medicine
  • Middle Aged
  • Outpatients
  • Process Assessment, Health Care
  • Referral and Consultation
  • Retina / pathology*
  • Specialization
  • Telepathology / standards
  • Time Factors