Original Article
Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

https://doi.org/10.1016/j.jcjo.2016.05.002Get rights and content

Abstract

Objective

The purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program’s cost-effectiveness.

Design

Retrospective chart review.

Participants

A total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013.

Methods

Focused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office.

Results

The average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%–18.7%). The average savings per tele-ophthalmology examination was $1007.

Conclusions

DR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.

RÉSUMÉ

Objectif

Évaluer le programme de dépistage de la rétinopathie diabétique (RD) par téléophtalmologie au Manitoba afin de déterminer la prévalence et l'incidence de la maladie et d'estimer la rentabilité du programme.

Nature

Étude rétrospective de dossiers.

Participants

4 676 patients atteints de diabète de type 2 examinés 9 334 fois de 2007 à 2013.

Méthodes

Des interviews et examens ophtalmiques ciblés ont été réalisés par du personnel infirmier qualifié, notamment sur l'acuité visuelle, la pression intraoculaire et la photographie mydriatique stéréoscopique des sept champs rétiniens standard. Les images ont été évaluées par des spécialistes de la rétine selon les critères de l'ETDRS (Early Treatment Diabetic Retinopathy Study). La prévalence et l'incidence de la RD ont ensuite été calculées au cours de la période d'étude. Nous avons estimé la rentabilité du programme en comparant le coût de l'exécution du programme de téléophtalmologie par rapport au coût du dépistage d'un même volume de patients en cabinet.

Résultats

La prévalence moyenne de toutes les formes de RD pour chaque année de l'étude était de 25,1 %. L'incidence cumulative de la RD dans les 6 années de l'étude était de 17,1 % (95 % IC, 15,4 % -18,7 %). L'économie moyenne s'élevait à 1 007 $ par examen de téléophtalmologie.

Conclusions

La rétinopathie diabétique est très répandue parmi la population étudiée. La téléophtalmologie est un moyen rentable d'assurer le suivi des patients et de dépister des maladies nouvelles ou traitables.

Section snippets

Methods

A retrospective chart analysis was performed on the MRSVP database using records from May 2007 to July 2013. Research ethics approval was obtained from the University of Manitoba and the Misericordia Hospital Research Ethics Boards. Patients were included if they were 18 years of age or older and had a diagnosis of type 2 diabetes mellitus. Charts were excluded if the acquired images were ungradable.

Community-based, mydriatic 7 standard field stereoscopic fundus photography was performed in

Results

From May 2007 to July 2013, a total of 4676 patients (54.9% female) from 49 communities were examined for a total of 9672 times. Of them, 338 cases (3.5%) were excluded from the study because of ungradable images (leaving a total of 9334 examinations for analysis). The mean age (± SD) for male patients was 53.7 (± 13.4) years, and for female patients it was 52.0 (± 14.1) years.

Of the patients, 2096 (44.8%) were examined only once over the 6 years of data. The percentage of patients examined 2,

Discussion

Diabetes is a significant public health issue in Canada and is associated with a variety of systemic complications, including DR. Canada lacks major epidemiological studies of vision loss, which may limit efforts in planning public policy.13 The present retrospective study is the largest of its kind in Canada and provides information on both rates of DR and the utility of tele-ophthalmology.

Previous epidemiological studies incorporating varying forms of tele-ophthalmology have been performed in

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

Acknowledgements

The authors wish to acknowledge the assistance of the following individuals: Abshir Moalin (Secure Diagnostics Imaging) and Brenda Weiss (Misericordia Health Centre).

References (27)

  • G.M. Zoega et al.

    Screening compliance and visual outcome in diabetes

    Acta Ophthalmol Scand

    (2005)
  • S.L. Mansberger et al.

    Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations

    JAMA Ophthalmol

    (2015)
  • N. Hautala et al.

    Marked reductions in visual impairment due to diabetic retinopathy achieved by efficient screening and timely treatment

    Acta Ophthalmol

    (2014)
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    Recipient of the 2015 Canadian Ophthalmological Society Award for Excellence in Ophthalmic Research (Poster).

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