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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.

Learning Objectives:

Jerry Cavallerano

Optometrist
Harvard Medical School

Dr. Jerry Cavallerano is Associate Professor of Ophthalmology, Harvard Medical School and Chief of the Center for Ocular Telehealth, Beetham Eye Institute. Dr. Cavallerano has been involved in telemedicine for over 15 years and has served as Chair, Ocular Telehealth Special Interest Group, American Telemedicine Association. During his chairmanship, the ATA published Telehealth Practice Recommendations for Diabetic Retinopathy, for which he was co-editor and principal author of the clinical components of the recommendations. Dr. Cavallerano currently oversees the clinical activities of the Joslin Vision Network. Dr. Cavallerano has participated in national clinical trials since 1981, including the Early Treatment Diabetic Retinopathy Study and the Diabetes Control and Complications Trial. Dr. Cavallerano has been responsible for image acquisition and reader certification within the Diabetes Detection and Care and Treatment Cooperative Study, and currently conducts programs to certify clinical readers/graders for the Joslin Vision Network BEI telemedicine programs since its inception in 1998.

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Ann Tolson

Joslin Vision Network Patient Care Coordinator
Joslin Diabetes Center

Ann Marie Tolson is Coordinator, Joslin Vision Network Clinical Programs, Beetham Eye Institute, Joslin Diabetes Center.

Ms. Tolson has been active in clinical telemedicine for diabetic retinopathy since the first clinical application of the Joslin Vision Network in June 1999. Ms. Tolson played an integral part in the design and execution of this initial JVN program.

In her role as Coordinator of Joslin Vision Network Clinical Programs in the Adult Diabetes Division of Joslin Clinic, Ms. Tolson coordinates the accessibility of appropriate imaging services to patients, triages reporting of JVN findings and recommended treatment plans, and oversees daily operations of the clinical programs. Her role includes patient/imager/reader/provider interaction, as well as communicating of the retinal findings to patients. She is certified as a Joslin Vision Network Imager and Program Coordinator.

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Dorothy Tolls

Optometrist
Joslin Diabetes Center

Dr. Dorothy Tolls is an Optometrist and Senior JVN Reader at the Center for Ocular Telehealth, Beetham Eye Institute. Formerly an Associate Professor of Optometry at the New England College of Optometry, Dr. Tolls has been involved in telemedicine for over 13 years. Currently, Dr. Tolls participates in the certification of clinical readers/graders for the Joslin Vision Network BEI telemedicine program and is a member of the Ocular Telehealth Special Interest Group, American Telemedicine Association.

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