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Oral Presentation

(CS11-03) Retinopathy Self-Awareness Deficits and Ophthalmic Follow-up Timeliness Among Diabetic Patients

Tuesday, April 25
1:25 PM - 1:45 PM
Location: W224 AB

Objectives
To assess the appropriateness of follow-up, patient awareness of diabetic retinopathy (DR) and status of current eye care among patients evaluated by an ocular telehealth program.

Methods
Prospective cross-sectional academic institution-based study comparing concurrent photographically documented DR severity with patient reported DR awareness and previously scheduled eye examination. Patient self-reported history of DR, time since last eye exam, and timing of next scheduled eye exam were recorded prior to retinal imaging and compared with DR severity determined by imaging. Records were obtained from 12,058 consecutive diabetic subjects who received concurrent retinal imaging but had not received previous eye care at the Joslin Diabetes Center from January 1, 2010 to July 15, 2016.

Results
At the time of imaging, (mean ± SD) age was 51.2±16.8 years, 54.7% male, 74.5% white, diabetes duration 11.4 ± 10.8 years, HbA1C 8.4% ± 2.0. Based on retinal photography, 60% (6,859) had no DR, 21.3% (2,399) had mild nonproliferative DR (NPDR) and 17.8% had vision-threatening DR (moderate NPDR or worse or any level of macular edema). Awareness of DR was reported in 3.0%, 9.6% and 47.8% of subjects with no, mild and vtDR respectively. Appropriately timed follow-up was reported in 57.5%, 54.9% and 12.2% of subjects with no, mild and vtDR, respectively. Among vtDR, 56%, 23% and 13% reported being aware of DR (P < 0.0001) and 31%, 14% and 7% reported timely follow-up (P= < 0.0001) when prior examination had been performed by a retina specialist, nonretina ophthalmologist or optometrist, respectively.A trend for increasing awareness was seen over time (1/2010-6/2013: 9.6%, 7/2013-7/2016: 11.48, p=0.0098).

Conclusion
In this cohort, although overall patient awareness of retinopathy may be increasing over 6 years, substantial discrepancies exist between the presence of retinal disease, patient-reported awareness and appropriateness of follow-up care for persons with diabetes. Although this discrepancy is related to eye care provider specialization, it exists across all provider types and DR severity, suggesting that modification of current medical care models to enhanced transfer and retention of ophthalmic knowledge to diabetic patients are urgently needed.

Paolo S. Silva

Staff Opthalmologist and Clinical Investigator
Beetham Eye Institute, Joslin Diabetes Center

Dr. Silva’s primary expertise lies in the fields of ocular telehealth for diabetic retinopathy, ultrawide field (UWF) retinal imaging and electronic medical record review. Dr. Silva has contributed 20 original articles (12 as either first or last author), 6 study group publications, 16 review articles and 7 book chapters. His work and efforts have been recognized with 8 national and international awards that include Young Clinician Award from the Center for Integration of Medicine and Innovative Technology and Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, Harvard Medical School. He has been recognized by Philippine President Benigno S. Aquino III as one of The Outstanding Young Men Awardee for Medicine in 2013 and the Presidential Award for Filipinos Overseas in 2014. Dr. Silva directs telemedicine and retinal imaging research programs that has led to collaborative efforts in Philippines with Joslin and the Diabetic Retinopathy Research Network (DRCR.net). Presently, the Philippine reading center is prospectively evaluating UWF angiograms and retrospectively evaluating optical coherence tomography scans from clinical trials conducted by DRCR.net.

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Ann M. Tolson

Patient Care Coordinator
Beetham Eye Institute, Joslin Diabetes Center

Ann Tolson, BA is reading center manager and coordinator of clinical activities for the BEI reading center programs. She is directly responsible for administrating scheduling and ongoing coverage of readers within the reading center. She has been with the reading center since its inception and has been involved in nearly all studies conducted by the reading center. In addition to her administrative responsibilities, she is a certified retinal imager with extensive experience in the assessment of image quality and its relation imaging process. She is highly involved in providing photographer/imager feedback to minimize imaging artifacts and improving imager quality through standardization of imaging technique in mydriatic, nonmydriatic and ultrawide field imaging.

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Joslin Tolls

Joslin Vision Network Image Grader
Beetham Eye Institute, Joslin Diabetes Center

Joslin Vision Network Image Grader

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Bina Patel

Joslin Vision Network Image Grader
Beetham Eye Institute, Joslin Diabetes Center

Joslin Vision Network Image Grader

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Mina Sehizadeh

Joslin Vision Network Image Grader
Beetham Eye Institute, Joslin Diabetes Center

Joslin Vision Network Image Grader

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Mina Thakore

Joslin Vision Network Image Grader
Beetham Eye Institute, Joslin Diabetes Center

Joslin Vision Network Image Grader

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Lloyd P. Aiello

Director
Beetham Eye Institute, Joslin Diabetes Center

Dr Aiello is internationally recognized as an expert in the area of diabetic retinopathy basic and clinical research and has an extensive clinical, biochemical and molecular biological understanding of diabetic eye disease especially in relation to VEGF and related growth factors. He has been instrumental in major translational approaches to bringing basic studies into the clinical arena for evaluation of diabetic eye disease. He has chaired numerous multi-national multicenter randomized controlled clinical trials in treatment of diabetic eye disease and was the inaugural chair of the NIH-sponsored Diabetic Retinopathy Clinical Research Network. He has extensive experience in diabetic patient evaluation, retinopathy assessment & treatment, directing clinical trials and diabetes-specific eye research.

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Jerry Cavallerano

Staff Optometrist and Clinical Investigator
Beetham Eye Institute, Joslin Diabetes Center

Jerry Cavallerano, OD, PhD, FAAO, is Associate Professor, Department of Ophthalmology, Harvard Medical School, Boston, MA and Staff Optometrist, Beetham Eye Institute, Joslin Diabetes Center, Boston, MA. Dr. Cavallerano received his Ph.D. from Fordham University, Bronx, NY and his O.D. from the New England College of Optometry.
Dr. Cavallerano served as a clinical co-investigator for the Diabetes Control and Complications Trial, the Early Treatment Diabetic Retinopathy Study, and other National Institutes of Health-sponsored clinical trials. He has assisted in the design and implementation of single-center trials on behalf of the National Eye Institute sponsored Diabetic Retinopathy Clinical Research Network (DRCR.net) and is a named author on the manuscripts from these studies. He serves both as a certified refractionist and visual acuity examiner for the DRCR.net as well as a certifying DRCR.net examiner for both of these activities.
Dr. Cavallerano served on the American Optometric Association’s (AOA) Clinical Care Guidelines Committee, co-authored the AOA’s Clinical Care Guideline on Optometric Care of the Patient with Diabetes, and previously was a co-author of the American Diabetes Association’s Clinical Practice Recommendations for Diabetic Retinopathy and the Technical Review to support the Clinical Practice Recommendations.
Dr. Cavallerano is former Chairman of the Ocular Telehealth Special Interest Group of the American Telemedicine Association and recognized leader in the field of ocular telemedicine, and a co-author of the ATA’s Telehealth Practice Recommendations for Diabetic Retinopathy. He serves as Chief, Beetham Eye Institute Center for Ocular Telehealth at the Joslin Diabetes Center.
Dr. Cavallerano serves on the Continuing Medical Education Committee, the Clinical Guidelines Committee, and the Committee on Human Studies Review Board at the Joslin Diabetes Center.
Dr. Cavallerano has authored or co-authored more than 85 articles, reviews, and book chapters, predominantly on diabetic retinopathy and ocular telemedicine, and he has lectured extensively on diabetic eye disease.
Dr. Cavallerano has served as editor of the New England Journal of Optometry and on the editorial boards of Diabetes Spectrum and Clinical Diabetes. He is presently on the scientific editorial review board of Review of Optometry and Telemedicine and e-Health and a reviewer for numerous journals.

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(CS11-03) Retinopathy Self-Awareness Deficits and Ophthalmic Follow-up Timeliness Among Diabetic Patients



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