2006. Tele-Retinal Imaging Improves Adherence with Diabetes Eye Care Guidelines
Paul R Conlin, MD, VA Boston Healthcare System and Harvard Medical School and New England College of Optometry, B Fisch, VA Boston Healthcare System and Harvard Medical School and New England College of Optometry, J Beard, VA Boston Healthcare System and Harvard Medical School and New England College of Optometry, A Cavallerano, VA Boston Healthcare System and Harvard Medical School and New England College of Optometry, G Selvin, VA Boston Healthcare System and Harvard Medical School and New England College of Optometry

Objectives: We tested the effect of the Joslin Vision Network (JVN) nonmydriatic tele-retinal imaging system on adherence with eye care guidelines and its level of agreement with a subsequent clinical examination.

Methods: Four hundred forty-eight patients were randomly assigned to have retinal imaging or not. We measured the number of patients having follow-up eye care (within 12 months) according to current guidelines and the level of agreement between JVN imaging and results from follow-up clinical examinations.

Results: The patients studied were average age 67 years, 88% white, 98% male, with average duration of diabetes >8 years. Patients who had JVN imaging (n = 223) were more adherent with subsequent eye care by an eye care professional over a 12 month follow-up period versus those who did not have imaging (n = 225) (Adherence: 87% vs. 77%, P=0.05). JVN imaging and the results of follow-up eye examinations showed significant concordance (r = 0.55; P<0.001) and a moderate level of agreement (kappa = 0.4). Patients reported much greater satisfaction with the digital retinal examination than with a dilated fundus examination.

Conclusions: JVN tele-retinal imaging findings were similar to those obtained during exam by an eye care professional. The imaging experience was readily accepted and significantly enhanced patients' adherence with guidelines for annual eye care.

Impact: Tele-retinal imaging in the ambulatory care setting enhances screening rates for diabetic retinopathy and likely adds an educational component that reinforces the need for regular eye care in patients with diabetes.