Implementing an ocular telehealth Diabetic Retinopathy Program in Andalusian (Spain).
Ortega C, Regife V, Mayoral E, Cornejo M and Aguilar M. Andalusian. 2008
INTRODUCTION.
Diabetic eye disease is a major cause of blindness in the Spain and remains one of the most serious complications of diabetes mellitus. In recent years laser treatment has been introduced that can significantly decrease the likelihood of blindness in diabetic patients, if the eyes are treated at the appropriate stage of the disease, so screening plays an important role in early detection and intervention to prevent the progression of diabetic retinopathy. In 2005, regular program of eye screening for diabetic retinopathy (DR) was initiated in Andalusian. The number of diabetic patients seen regularly has increased considerably since then. We now report on our active screening program (SP) for diabetic eye disease and describe the eye condition of the diabetic patients who have been involved in this program.
RESEARCH DESIGN AND METHOD.
We embarked on a retrospective study to evaluate the prevalence of retinopathy of the type 1 and type 2 patients participating in our program. The characteristics of screening programme being that the target patients in the community are found and seen at the prescribed intervals, and that the physician who conduct the screening have adequate training for the manifestations of diabetic eye disease with methods of photoscreening with a fundus camera Telehealth programs for DR depend upon four elements of care: image acquisition; image review and evaluation; patient care supervision; and image and data storage. . The physician send ( web-system) to ophthalmologist the photographs in order to confirm evidence of DR . The camera can also be bought to remote rural areas and the pictures in this moment or later examined. Photoscreening will not always detect subtle signs of DR , such as retinal thickening, but a success rate of 80-92% in detecting DR is claimed by researchers.Three photographs spread across the posterior pole are now widely regarded as being most cost efficient .RESULTS
Source population estimated of diabetics is 305000 patients , included SP to October 2008, 92635 patients. Retinopathy was present in 5886 (9%), patients nonproliferative mild or moderate DR 5251 (93%) , severe DR 366 (6%) and proliferative retinopathy in 59 (1%) .
In program for DR ,300 Health’s Center and 36 Hospital participated. 830 General Practitioners , 138 ophthalmologist, 660 nurses and another professionals (620). It used 106 retinal photography
CONCLUSION
Screening by retinal photography is not a substitute for a comprehensive ophthalmic examination, but there is level I evidence that it can serve as a screening tool for diabetic retinopathy to identify patients with retinopathy for referral for ophthalmic evaluation and management. Telehealth programs based on digital retinal imagery have the potential to allow increased diagnoses of DR, improving access to diagnosis resulting in timely treatment and preservation of vision.