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Oral Presentation

(CS11-01) Four-year Experience of Tele-ophthalmology for Diabetic Retinopathy Screening in San Francisco, CA

Tuesday, April 25
12:45 PM - 1:04 PM
Location: W224 AB

Objectives
The objective of this study was to analyze data from the San Francisco Department of Public Health's Tele-Ophthalmology screening program, which was started in 2012.

Methods
This was a prospective cohort study, with patients between 10/2012 - 9/2016. Diabetic patients with no prior eye care were referred from primary care physicians for eye screening at one of three sites (San Francisco General Hospital, Chinatown Public Health Center and Southeast Health Center). Un-dilated fundus photographs were taken with the Optos Daytona camera (Optos, Scotland, UK). All images were read by trained optometrists and ophthalmologists using the Joslin Vision Network (JVN) screening criteria. Patients with ophthalmic disease requiring medical referral were sent to the ophthalmology clinic for further care. Outcome measurements included rates of retinopathy, cataract and glaucoma.

Results
A total of 2586 patients were screened. 2504 (98.6%) images were gradeable; 82 (3.17%) were un-gradeable due to media opacity or poor quality photograph. No retinopathy was seen in 1705 (68.1%) patients. Diabetic retinopathy was seen in 799 (31.9%) patients, among whom mild and moderate non-proliferative diabetic retinopathy were seen in 564 (70.6%) and 140 (17.5%) patients, respectively. Severe/proliferative diabetic retinopathy was seen in 98 (11.9%) patients and macular edema in 48 (6%) patients with retinopathy. Other common co-morbid diseases in the patients with diabetic retinopathy were cataract in 137 (17.9%) and glaucoma in 292 (38.2%). 1846 (70.7%) of patients were scheduled for annual follow up; 764 (29.2%) patients were referred for an ophthalmology exam within 1-6 months for detected eye diseases.

Conclusion
This pilot study demonstrates successful implementation of a diabetic retinopathy telemedicine screening program in a large urban population (San Francisco, CA). Nearly one third of patients had detectable diabetic retinopathy, and 29.3% of patients screened had findings warranting referral to an ophthalmologist. Data collection and analysis in this study is ongoing. Further investigation involving cost-benefit analysis of this screening program will be presented.

Armin R. Afshar

Assistant Professor of Ophthalmology, UCSF; Director of Tele-ophthalmology, San Francisco Department of Public Health
University of California San Francisco

Dr. Armin Afshar is an ophthalmologist at UCSF's Retina and and Ocular Oncology Clinics. He specializes in the disorders of the retina and treatment of eye tumors. He has special expertise in the management of diabetic retinopathy, macular degeneration, retinal vascular diseases, ocular surface tumors of the conjunctiva and cornea, as well as intra-ocular tumors involving the iris, ciliary body, choroid, retina and the vitreous and optic nerves. His research focuses on tele-retinopathy screening, genetic analysis of uveal melanomas and improving treatments for retinoblastoma.

Afshar earned his bachelor of science and medical degree in the accelerated honors medical program at the University of Illinois College of Medicine at Chicago, and a master's degree in business administration at the University of Chicago. He completed a residency in ophthalmology at the University of Chicago and fellowships in vitreoretinal surgery and ocular oncology at UCSF. He is an assistant professor of ophthalmology and a member of the American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retinal Specialists, American Association of Ophthalmic Oncologists and Pathologists and International Society of Ocular Oncology.

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Joseph Alsberge

Resident Physician in Ophthalmology, PGY-4
University of California San Francisco

Dr. Joseph Alsberge is a senior resident in ophthalmology at UCSF and will be pursuing advanced specialty training in Vitreoretinal Diseases and Surgery. Dr. Alsberge is a graduate of Weill Cornell Medical College. His research interests include diabetic retinopathy and tele-ophthalmology screening.

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Cynthia S. Chiu

Associate Professor of Ophthalmology
University of California San Francisco

Dr. Cynthia Chiu is a general ophthalmologist specializing in cataract surgery and comprehensive eye care. She also has special interest in medical education and surgical instruction of ophthalmology residents. Dr. Chiu led the San Francisco Department of Public Health's tele-ophthalmology screening program from 2012 to July 2016.

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Bruce Occeña

Director of Telehealth Services
San Francisco Department of Public health

Bruce Occeña has over twenty years of experience in the field of public health focused primarily on substance abuse prevention and treatment, HIV outreach and counseling, and homeless services. His overarching focus has been increasing access to care for marginalized populations.
Bruce's current efforts are focused on increasing access to interpreter services in public health settings. In the area of substance abuse services, he has a full range of experiences as a clinician, planner, evaluator and administrator. He is the Director of Tele-health Services for the San Francisco Department of Public Health and is also an instructor at City College of San Francisco, where he teaches the Criminology & Addiction course.

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Becca Barczykowski

Telehealth Program Coordinator
San Francisco Department of Public Health

Ms. Becca Barczykowski serves as the coordinator for the tele-health program for the San Francisco Department of Public Health. She has a special research interest in tele-ophthalmology and mobile eye care services.

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James Larson

Clinic Supervisor
Zuckerberg San Francisco General Hospital and Trauma Center

Mr. James Larson is the clinic supervisor for the Ophthalmology Clinic at Zuckerberg San Francisco General Hospital and Trauma Center. He plays an integral role in the Diabetic Tele-retinopathy program and is involved in data collection and analysis.

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George Su

Associate Professor of Medicine
University of California San Francisco

Dr. Su is an associate professor of Medicine at UCSF and assistant director of the telehealth program for the San Francisco Department of Public Health.

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Jay M. Stewart

Professor of Clinical Ophthalmology, UCSF; Chief of Ophthalmology, ZSFGH
University of California San Francisco

Dr. Jay Stewart is an ophthalmologist who specializes in the treatment of the retina and vitreous, a thick, transparent substance that fills the center of the eye. His expertise includes treating conditions such as age-related macular degeneration, diabetic retinopathy, ocular trauma, retinal detachment, retinal vascular diseases and uveitis, which is the swelling and irritation of the uvea, the middle layer of the eye that provides most of the blood supply to the retina.

Stewart earned a medical degree at Harvard Medical School and completed a residency in ophthalmology at UCSF. He completed a fellowship at the Doheny Eye Institute at the University of Southern California in Los Angeles and won the Ronald G. Michels Fellowship Foundation Award in Vitreoretinal Surgery, which funds young scholars, in 2004. In his research, Stewart studies diabetic retinopathy, drug delivery to the eye and the permeability and biomechanics of eye tissues. He is a member of the American Academy of Ophthalmology, American Society of Retina Specialists and Retina Society. Stewart is a professor of clinical ophthalmology at UCSF and the chief of ophthalmology and eye care services at the Zuckerberg San Francisco General Hospital and Trauma Center.

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Andrea Yiasemis

Optometrist, Zuckerberg San Francisco General Hospital and Trauma Center
University of California, San Francisco

Dr. Yiasemis is an Optometrist at the Zuckerberg San Francisco General Hospital and Trauma Center in San Francisco, CA. She earned her Doctor of Optometry Degree from the University of California, Berkeley. Her research interests are focused on tele-ophthalmology screenings and improving access to eye care services.

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(CS11-01) Four-year Experience of Tele-ophthalmology for Diabetic Retinopathy Screening in San Francisco, CA



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