Telemedicine Retinal Screening Utilizing a Mobile Medical Unit
Condition: Diabetes; Retinopathy
MeSH terms: Retinal Diseases
Study type: Observational

Summary: 
      Objective: To test the accuracy of a referral system for diabetic eye disease conducted by a
      trained screener using a digital camera, a mobile medical unit and a centralized
      image-storing software in underserved, ethnically diverse neighborhoods in San Diego.

      Methods and Research Design: Retinal screening exams were offered at 8 community health
      centers for 1229 individuals, ages 16-80 years with diabetes throughout San Diego County over
      18 months. Images were captured with a special digital camera, securely transferred to a
      software system and read independently by a trained technician and retinal specialist. An
      analysis was conducted to evaluate who had severe eye disease and how accurate the reading of
      the technician were compared to the expert ophthalmologist readings.

      The investigators would like to demonstrate that telemedicine retinal screening utilizing a
      mobile medical unit with a trained technician in high-risk, ethnically diverse populations
      can accurately detect positive and negative disease. This may be a model to increase access
      to retinal examination in order to meet current guidelines and can allow more efficient use
      of the retinal specialist to evaluate and treat disease leading to a more cost efficient
      method of care.
    

Detailed description: 
      Objective: To test the validity and accuracy of a grading and referral system for diabetic
      retinopathy conducted by a trained screener using a digital camera, a mobile medical unit and
      a centralized image-storing software in underserved, ethnically diverse neighborhood
      community health centers Methods and Research Design: Retinal screening exams using
      telemedicine technology were offered at 8 community health centers for 1229 individuals, ages
      16-80 years with diabetes throughout San Diego County over 18 months. Images were
      electronically captured, transferred to EyePACs1 image software and read independently by a
      trained technician and retinal specialist. Statistical analysis was conducted to evaluate
      prevalence of disease and accuracy and validity of readings. Snellen eye test and glaucoma
      testing using tonometry will also be conducted.

      Results: Will evaluate demographics that include age, gender, ethnicity, duration of
      diabetes, type of diabetes and need for dilation. Severity of disease will be captured.
      Statistical analysis will be conducted for technician accuracy of grading the readings.

      Conclusions: To demonstrate that telemedicine retinal screening utilizing a mobile medical
      unit with a trained technician in high-risk, ethnically diverse populations can accurately
      detect positive and negative screens. This may be a model to increase access to retinal
      examination in order to meet ADA and HEDIS guidelines and can allow more efficient use of the
      retinal specialist to evaluate and treat disease leading to a more cost efficient method of
      care.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Men and Women, ages 16-80 with type 1 and type 2 diabetes mellitus identified from 8
        community health centers in San Diego County.
      
Keywords: screening; diabetic retinopathy