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A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening.
Ophthalmol Retina. 2019 07; 3(7):576-579.OR

Abstract

PURPOSE

To describe a new approach for telemedicine screening of diabetic retinopathy (DR) using a combination of a mobile ultra-widefield camera, mounted in a van and able to travel to areas of need, and several fixed-location cameras in high-volume clinics and to report predictors of DR in a diverse urban population of 2788 patients.

DESIGN

Cross-sectional study.

PARTICIPANTS

Two thousand seven hundred eighty-eight patients enrolled in the San Francisco Health Network who underwent DR screening using the novel hybrid telemedicine system.

METHODS

The study was carried out at Zuckerberg San Francisco General Hospital in the San Francisco Health Network. A van was specially equipped to allow an ultra-widefield fundus camera to be mounted inside, and the van was sent with a technician to primary care clinics throughout the city on a rotation schedule determined according to clinical need. Additional fundus cameras were placed in several high-volume clinic locations. Patient demographic and clinical information was collected at the time of screening. Photographs were transmitted to a reading center and were graded for DR and other findings by trained readers.

MAIN OUTCOME MEASURES

Prevalence of DR subtypes and odds ratios for development of DR and proliferative DR (PDR).

RESULTS

The hybrid mobile and fixed-location ultra-widefield camera screening system was able to be deployed to carry out the telemedicine screening program for diabetic patients throughout the city of San Francisco referred for screening during the period of the study. Of 2788 patients screened, 736 (27%) were found to have DR. Of these, 34 (5%) had PDR, and 702 (95%) had nonproliferative DR. In multivariate analysis, factors found to be associated with development of any DR were diabetes duration, hemoglobin A1C level, insulin use, and end-organ damage. Diabetes duration was the only factor associated with PDR.

CONCLUSIONS

Diabetic retinopathy screening can be accomplished in an urban setting using a combination of fixed-location and mobile ultra-widefield cameras to extend the reach of the screening opportunity throughout a health network. In a diverse group of patients, factors associated with DR and PDR were identified and support ongoing efforts to screen for retinopathy and maintain diabetic control.

Authors+Show Affiliations

Department of Ophthalmology, University of California, San Francisco, San Francisco, California.Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.Department of Ophthalmology, University of California, San Francisco, San Francisco, California. Electronic address: Jay.Stewart@ucsf.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31076334

Citation

Afshar, Armin R., et al. "A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening." Ophthalmology. Retina, vol. 3, no. 7, 2019, pp. 576-579.
Afshar AR, Oldenburg CE, Stewart JM. A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening. Ophthalmol Retina. 2019;3(7):576-579.
Afshar, A. R., Oldenburg, C. E., & Stewart, J. M. (2019). A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening. Ophthalmology. Retina, 3(7), 576-579. https://doi.org/10.1016/j.oret.2019.03.007
Afshar AR, Oldenburg CE, Stewart JM. A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening. Ophthalmol Retina. 2019;3(7):576-579. PubMed PMID: 31076334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Novel Hybrid Fixed and Mobile Ultra-Widefield Imaging Program for Diabetic Teleretinopathy Screening. AU - Afshar,Armin R, AU - Oldenburg,Catherine E, AU - Stewart,Jay M, Y1 - 2019/03/20/ PY - 2019/01/06/received PY - 2019/02/19/revised PY - 2019/03/12/accepted PY - 2019/5/12/pubmed PY - 2020/6/27/medline PY - 2019/5/12/entrez SP - 576 EP - 579 JF - Ophthalmology. Retina JO - Ophthalmol Retina VL - 3 IS - 7 N2 - PURPOSE: To describe a new approach for telemedicine screening of diabetic retinopathy (DR) using a combination of a mobile ultra-widefield camera, mounted in a van and able to travel to areas of need, and several fixed-location cameras in high-volume clinics and to report predictors of DR in a diverse urban population of 2788 patients. DESIGN: Cross-sectional study. PARTICIPANTS: Two thousand seven hundred eighty-eight patients enrolled in the San Francisco Health Network who underwent DR screening using the novel hybrid telemedicine system. METHODS: The study was carried out at Zuckerberg San Francisco General Hospital in the San Francisco Health Network. A van was specially equipped to allow an ultra-widefield fundus camera to be mounted inside, and the van was sent with a technician to primary care clinics throughout the city on a rotation schedule determined according to clinical need. Additional fundus cameras were placed in several high-volume clinic locations. Patient demographic and clinical information was collected at the time of screening. Photographs were transmitted to a reading center and were graded for DR and other findings by trained readers. MAIN OUTCOME MEASURES: Prevalence of DR subtypes and odds ratios for development of DR and proliferative DR (PDR). RESULTS: The hybrid mobile and fixed-location ultra-widefield camera screening system was able to be deployed to carry out the telemedicine screening program for diabetic patients throughout the city of San Francisco referred for screening during the period of the study. Of 2788 patients screened, 736 (27%) were found to have DR. Of these, 34 (5%) had PDR, and 702 (95%) had nonproliferative DR. In multivariate analysis, factors found to be associated with development of any DR were diabetes duration, hemoglobin A1C level, insulin use, and end-organ damage. Diabetes duration was the only factor associated with PDR. CONCLUSIONS: Diabetic retinopathy screening can be accomplished in an urban setting using a combination of fixed-location and mobile ultra-widefield cameras to extend the reach of the screening opportunity throughout a health network. In a diverse group of patients, factors associated with DR and PDR were identified and support ongoing efforts to screen for retinopathy and maintain diabetic control. SN - 2468-6530 UR - https://www.unboundmedicine.com/medline/citation/31076334/A_Novel_Hybrid_Fixed_and_Mobile_Ultra_Widefield_Imaging_Program_for_Diabetic_Teleretinopathy_Screening_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2468-6530(19)30010-7 DB - PRIME DP - Unbound Medicine ER -