Diabetic retinopathy is the leading cause of impairment and blindness in the working population (1), yet little is known about eye examination rates in rural and ethnically diverse communities. We examined a model of health care delivery utilizing telemedicine in a primary care setting to improve retinal examination rates in a rural and ethnically diverse community in South Carolina.
A randomized clinical trial was conducted to formally evaluate the effectiveness of a telemedicine retinal screening program (TRSP) compared with usual care. TRSP involved use of a nonmydriatic retinal camera located in a rural, federally funded primary care practice. An ophthalmologist located at the university setting distant from the primary care practice site evaluated the retinal photograph and consulted with the patient using real-time video conferencing. The outcome of interest for this trial was the frequency of eye examinations. Selection criteria included adults aged >18 years with a physician diagnosis of diabetes of any duration and any form of treatment.
Participants (n = 59) included 53 African Americans (90%), and 21 participants (35.5%) had no insurance or were on a sliding scale. Of those randomized to the TRSP (n = 30), 23 (77%) obtained eye examinations compared with 4 of 29 usual care patients (14%), who obtained eye examinations through their eye-care providers (relative risk 5.56, 95% CI 2.19–14.10). Thus, patients who had the opportunity to receive their eye examination via telemedicine at the primary care practice site were approximately six times more likely to obtain a screening eye examination than those who were simply reminded to schedule examinations with their usual eye-care provider.
The importance of this finding is underscored by reported annual dilated eye examination rates <50% and by the fact that much of the blindness attributed to diabetic retinopathy is preventable by timely photocoagulation (2,3). The incidence rate of 14% in our standard care group is quite low but comparable with that in other similar community health centers in rural South Carolina.
This model of eye-care delivery bridges certain barriers, such as transportation and access, in that patients obtained retinal screening examinations in the familiar offices of their primary care physicians. Despite the small sample size, our TRSP elicited greater adherence to vision care guidelines for patients with diabetes living in an underserved and ethnically diverse community. Future translational research can evaluate the potential effectiveness of telemedicine technology to improve adherence to clinical practice guidelines for diabetes care.
