Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine

doi:10.1001/jamaophthalmol.2014.4652

Multicenter Study

. 2015 Feb;133(2):174-81.

doi: 10.1001/jamaophthalmol.2014.4652.

Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine

Cynthia Owsley¹, Gerald McGwin Jr², David J Lee³, Byron L Lam⁴, David S Friedman⁵, Emily W Gower⁶, Julia A Haller⁷, Lisa A Hark⁷, Jinan Saaddine⁸; Innovative Network for Sight (INSIGHT) Research Group

Collaborators, Affiliations

Collaborators

Innovative Network for Sight (INSIGHT) Research Group:
Jinan Saaddine, Jinan Saaddine, Juanita Mondesire, John Crews, Ed Gregg, Desmond Williams, Bernice Moore, David S Friedman, Emily W Gower, Sheila K West, Beatriz Munoz, Claudia Campos, Craig Greven, Nathan Haines, Daniel Nelson, Carolyn Pedley, Ramon Valez, Diayll Sells, Karlee Lanning, Michelle Matthews, Cynthia Owsley, Gerald McGwin Jr, Sandral Hullett, Laura Dreer, Christine Heckemeyer, Christopher Girkin, Wendy Sykes Horn, Virginia Lolley, Paul MacLennan, Stephen Mennemeyer, Lindsay Rhodes, Mark Swanson, Karen Searcey, Lindsay Gregg, Mark Clark, Angela McKinney, David Lee, Margaret Byrne, Byron Lam, Laura McClure, Manuel Ocasio, Dorothy Parker, Marsha Stevens, Kristopher Arheart, Diane Zheng, Yolanda Davis-Camacho, Stephanie Oliden, Tracy Similien, Yanel Diaz, Julia A Haller, Ann P Murchison, Laura T Pizzi, Lisa A Hark, Yang Dai, Benjamin Leiby, Shae Reber, Jay Federman, Carl Park

Affiliations

¹ Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham.
² Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
³ Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
⁴ Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
⁵ Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
⁶ Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland6Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina7Department of Ophthalmology, Wake Forest Sc.
⁷ Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
⁸ Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.

PMID: 25393129
PMCID: PMC4479273
DOI: 10.1001/jamaophthalmol.2014.4652

Multicenter Study

Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine

Cynthia Owsley et al. JAMA Ophthalmol. 2015 Feb.

. 2015 Feb;133(2):174-81.

doi: 10.1001/jamaophthalmol.2014.4652.

Authors

Collaborators

Innovative Network for Sight (INSIGHT) Research Group:
Jinan Saaddine, Jinan Saaddine, Juanita Mondesire, John Crews, Ed Gregg, Desmond Williams, Bernice Moore, David S Friedman, Emily W Gower, Sheila K West, Beatriz Munoz, Claudia Campos, Craig Greven, Nathan Haines, Daniel Nelson, Carolyn Pedley, Ramon Valez, Diayll Sells, Karlee Lanning, Michelle Matthews, Cynthia Owsley, Gerald McGwin Jr, Sandral Hullett, Laura Dreer, Christine Heckemeyer, Christopher Girkin, Wendy Sykes Horn, Virginia Lolley, Paul MacLennan, Stephen Mennemeyer, Lindsay Rhodes, Mark Swanson, Karen Searcey, Lindsay Gregg, Mark Clark, Angela McKinney, David Lee, Margaret Byrne, Byron Lam, Laura McClure, Manuel Ocasio, Dorothy Parker, Marsha Stevens, Kristopher Arheart, Diane Zheng, Yolanda Davis-Camacho, Stephanie Oliden, Tracy Similien, Yanel Diaz, Julia A Haller, Ann P Murchison, Laura T Pizzi, Lisa A Hark, Yang Dai, Benjamin Leiby, Shae Reber, Jay Federman, Carl Park

Affiliations

¹ Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham.
² Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
³ Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
⁴ Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
⁵ Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
⁶ Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland6Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina7Department of Ophthalmology, Wake Forest Sc.
⁷ Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
⁸ Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.

PMID: 25393129
PMCID: PMC4479273
DOI: 10.1001/jamaophthalmol.2014.4652

Erratum in

Omission in article information.
[No authors listed] [No authors listed] JAMA Ophthalmol. 2015 May;133(5):621. doi: 10.1001/jamaophthalmol.2015.1176. JAMA Ophthalmol. 2015. PMID: 25974651 No abstract available.

Abstract

Importance: The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care.

Objective: To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings.

Design, setting, and participants: A cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings.

Main outcomes and measures: The percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings.

Results: A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract.

Conclusions and relevance: In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated.

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Figures

**Figure 1**
Percentage of sample with various levels of diabetic retinopathy in either eye stratified by site and overall

**Figure 2**
Percentage of the sample having other ocular findings in either eye stratified by site.

See this image and copyright information in PMC

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References

1. Centers for Disease Control and Prevention . National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. US Department of Health and Human Services; Atlanta GA: 2014. http://www.cdc.gov/diabetes/pubs/statsreport14.htm.
1. Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050. Diabetes Care. 2001;24:1936–1940. - PubMed
1. Saaddine JB, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseaes among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126:1740–1747. - PubMed
1. Zhang X, Saaddine JB, Chou C-F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304:649–656. - PMC - PubMed
1. Rein D, Zhang P, Wirth K, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124:1754–1760. - PubMed

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[1] Centers for Disease Control and Prevention . National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. US Department of Health and Human Services; Atlanta GA: 2014. http://www.cdc.gov/diabetes/pubs/statsreport14.htm.

[2] Centers for Disease Control and Prevention . National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. US Department of Health and Human Services; Atlanta GA: 2014. http://www.cdc.gov/diabetes/pubs/statsreport14.htm.

[3] Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050. Diabetes Care. 2001;24:1936–1940. - PubMed

[4] Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050. Diabetes Care. 2001;24:1936–1940. - PubMed

[5] Saaddine JB, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseaes among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126:1740–1747. - PubMed

[6] Saaddine JB, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseaes among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126:1740–1747. - PubMed

[7] Zhang X, Saaddine JB, Chou C-F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304:649–656. - PMC - PubMed

[8] Zhang X, Saaddine JB, Chou C-F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304:649–656. - PMC - PubMed

[9] Rein D, Zhang P, Wirth K, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124:1754–1760. - PubMed

[10] Rein D, Zhang P, Wirth K, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124:1754–1760. - PubMed

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Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine

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Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine

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