Effect of a teleretinal screening program on eye care use and resources

JAMA Ophthalmol. 2014 Sep;132(9):1045-51. doi: 10.1001/jamaophthalmol.2014.1051.


Importance: Telemedicine is a useful clinical method to extend health care to patients with limited access. Minimal information exists on the subsequent effect of telemedicine activities on eye care resources.

Objective: To evaluate the effect of a community-based diabetic teleretinal screening program on eye care use and resources.

Design, setting, and participants: The current study was a retrospective medical record review of patients who underwent diabetic teleretinal screening in the community-based clinics of the Atlanta Veterans Affairs Medical Center from October 1, 2008, through March 31, 2009, and who were referred for an ophthalmic examination in the eye clinic.

Exposures: Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions.

Main outcomes and measures: The accuracy between referring and final diagnoses and the eye care resources that were used in the care of referred patients.

Results: The most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement among these 5 visually significant diagnoses was 90.4%, with a total sensitivity of 73.6%. 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 $1000.

Conclusions and relevance: 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.

MeSH terms

  • Adult
  • Aged
  • Cataract / diagnosis
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / therapy
  • Female
  • Health Resources / economics
  • Health Resources / statistics & numerical data*
  • Health Services Research
  • Humans
  • Macular Degeneration / diagnosis
  • Macular Edema / diagnosis
  • Male
  • Middle Aged
  • Ophthalmology / economics
  • Ophthalmology / statistics & numerical data*
  • Optic Nerve Diseases / diagnosis
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Referral and Consultation
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Telemedicine / economics
  • Telemedicine / statistics & numerical data*
  • United States
  • United States Department of Veterans Affairs
  • Veterans Health / economics
  • Veterans Health / statistics & numerical data*
  • Vision Screening / statistics & numerical data*