EP-119 - Accessible Nonmydriatic Retinal Imaging Increases Diabetes Surveillance Rates
Tuesday, May 1
9:35 AM - 9:50 AM
Location: Education Zone, Booth 2416, Screen 1
We present a retrospective, comparative cohort study of patients imaged from 04/01/2016-03/31/2017 with NM-UWFI provided without additional cost beginning 10/16/2016. Patients were offered retinal imaging if they were presenting for initial examination at Joslin Diabetes Center or did not have an eye examination at the Beetham Eye Institute of the Joslin Diabetes Center within the previous 12 months. Based on these criteria, a prompt to offer imaging was embedded in the electronic medical record. Images were evaluated for DR and diabetic macular edema (DME) using a standard protocol at a centralized reading center with certified graders. Standardized ocular history and DR awareness were obtained on all patients.
A total of 759 and 2,080 patients was imaged using NM-UWFI during the 130 working days before and after the initiation of no-fee imaging on 10/16/2016, respectively. The difference represents a 274% increase in the number of patients imaged after 10/16/2016. There were no statistically significant differences between groups in the distribution of DR severity (before: 50.2% no DR, 30.1% mild DR and 19.7% referable DR; after 48.9%, 32.3%, 18.8%, p=0.54). However, with the increased surveillance rates, there was a 292% increase in the number of eyes with mild DR and a 261% increase in referable DR that required closer follow-up and possible treatment. Ninety-two additional cases of proliferative DR were identified, which would prevent 6.7 cases of severe visual loss, with a total cost savings of $211,874 (cost of severe loss = $31,623). No differences were observed in gender, ethnicity, or HbA1c. In this cohort in patients with referable DR, self-awareness was low over-all, with no significant difference between the before and after groups (39.4% vs 43.8%, p 0.3725).
In summary, providing NM-UWFI as part of comprehensive diabetes care increased the number of patients identified by nearly 3-fold. These data suggest the removal of barriers to eye care may substantially increase patient surveillance rates which should translate into improved long-term patient outcomes.
- Recognize the impact of increased accessibility on surveillance rate for diabetic retinopathy
- Understand impact of out of pocket costs in a telemedicine program as a barrier to increased surveillance for diabetic retinopathy.
- Demonstrate the value of retinal screening as part of comprehensive diabetes care at no additional cost to patients or their insurers at a tertiary academic diabetes specific medical center.