Skip to main content

Advertisement

Log in

Ocular telehealth initiatives in diabetic retinopathy

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Diabetic retinopathy (DR) is a common complication of diabetes mellitus and a leading cause of new-onset vision loss in adults worldwide. Current medical and surgical evidence-based care, including laser photocoagulation, is effective in preserving vision. This care is most effective prior to the onset of ocular or visual symptoms, but many diabetic persons do not receive the recommended annual eye examination for the evaluation of the retina for level of DR. With diabetes incidence and prevalence increasing at epidemic rates and the prediction that 370 million people worldwide will have diabetes by the year 2030, human and fiscal resources will be unable to meet the visual needs with current acute care methods. Appropriate and validated telemedicine programs for DR hold the promise of both enrolling patients into appropriate eye care programs and, more importantly, providing more effective, high-quality diabetes eye care based on current and developing technology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol 1985, 103:1796–1806.

  2. Aiello LM, Ferris FL III: Photocoagulation for diabetic macular edema. Arch Ophthalmol 1987, 105:1163.

    PubMed  CAS  Google Scholar 

  3. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981, 88:583–600.

  4. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991, 98:766–785.

  5. Ferris F: Early photocoagulation in patients with either type I or type II diabetes. Trans Am Ophthalmol Soc 1996, 94:505–537.

    PubMed  CAS  Google Scholar 

  6. The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial. Arch Ophthalmol 1995, 113:36–51.

  7. White NH, Sun W, Cleary PA, et al.: Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. Arch Ophthalmol 2008, 126:1707–1715.

    Article  PubMed  Google Scholar 

  8. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N Engl J Med 2000, 342:381–389.

  9. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003, 290:2159–2167.

  10. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998, 352:837–853.

  11. Holman RR, Paul SK, Bethel MA, et al.: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359:1577–1589.

    Article  PubMed  CAS  Google Scholar 

  12. Aiello LP, Cahill MT, Wong JS: Systemic considerations in the management of diabetic retinopathy. Am J Ophthalmol 2001, 132:760–766.

    Article  PubMed  CAS  Google Scholar 

  13. Sjolie AK, Stephenson J, Aldington S, et al.: Retinopathy and vision loss in insulin-dependent diabetes in Europe. The EURODIAB IDDM Complications Study. Ophthalmology 1997, 104:252–260.

    PubMed  CAS  Google Scholar 

  14. UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Res 1990, 13:1–11.

    Google Scholar 

  15. Chew EY, Klein ML, Ferris FL III, et al.: Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Ophthalmol 1996, 114:1079–1084.

    PubMed  CAS  Google Scholar 

  16. American Telemedicine Association: Telemedicine Defined. Available at http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333. Accessed March 25, 2009.

  17. Centers for Disease Control and Prevention: National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.

    Google Scholar 

  18. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27:1047–1053.

    Article  PubMed  Google Scholar 

  19. Kempen JH, O’Colmain BJ, Leske MC, et al.: The prevalence of diabetic retinopathy among adults in the United States. Arch Ophthalmol 2004, 122:552–563.

    Article  PubMed  Google Scholar 

  20. Klein R, Klein BE: Vision disorders. In Diabetes in America. Edited by Harrris MW. Bethesda, MD: NIHNIDDK Publication No. 95-1468; 1995:293–338.

    Google Scholar 

  21. Brechner RJ, Cowie CC, Howie LJ, et al.: Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA 1993, 270:1714–1718.

    Article  PubMed  CAS  Google Scholar 

  22. Will JC, German RR, Schuman E, et al.: Patient adherence to guidelines for diabetes eye care: results from the diabetic eye disease follow-up study. Am J Public Health 1994, 84:1669–1671.

    Article  PubMed  CAS  Google Scholar 

  23. Wang F, Javitt JC: Eye care for elderly Americans with diabetes mellitus. Failure to meet current guidelines. Ophthalmology 1996, 103:1744–1750.

    PubMed  CAS  Google Scholar 

  24. Fong DS, Aiello L, Gardner TW, et al.: Retinopathy in diabetes. Diabetes Care 2004, 27(Suppl 1):S84–S87.

    Article  PubMed  Google Scholar 

  25. American Academy of Ophthalmology Retina Panel: Preferred Practice Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2008.

    Google Scholar 

  26. American Optometric Consensus Panel on Diabetes: Care of the Patient with Diabetes Mellitus. St Louis, MO: American Optometric Association; 2002.

    Google Scholar 

  27. Cavallerano J, Lawrence MG, Zimmer-Galler I, et al.: Telehealth practice recommendations for diabetic retinopathy. Telemed J E Health 2004, 10:469–482.

    Article  PubMed  Google Scholar 

  28. Whited JD: Accuracy and reliability of teleophthalmology for diagnosing diabetic retinopathy and macular edema: a review of the literature. Diabetes Technol Ther 2006, 8:102–111.

    Article  PubMed  Google Scholar 

  29. Meigs JB, Cagliero E, Dubey A, et al.: A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project. Diabetes Care 2003, 26:750–757.

    Article  PubMed  Google Scholar 

  30. Aravind Eye Care System: Activity Report 2007–2008. Available at http://www.aravind.org/annualreport08/displayreport.aspx?qstring=Performance. Accessed March 25, 2009.

  31. Perumalsamy N, Prasad NM, Sathya S, Ramasamy K: Software for reading and grading diabetic retinopathy: Aravind Diabetic Retinopathy Screening 3.0. Diabetes Care 2007, 30:2302–2306.

    Article  PubMed  Google Scholar 

  32. Gomez-Ulla F, Fernandez MI, Gonzalez F, et al.: Digital retinal images and teleophthalmology for detecting and grading diabetic retinopathy. Diabetes Care 2002, 25:1384–1389.

    Article  PubMed  Google Scholar 

  33. Taylor CR, Merin LM, Salunga AM, et al.: Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: the Vine Hill study. Diabetes Care 2007, 30:574–578.

    Article  PubMed  Google Scholar 

  34. Fransen SR, Leonard-Martin TC, Feuer WJ, Hildebrand PL: Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system. Ophthalmology 2002, 109:595–601.

    Article  PubMed  Google Scholar 

  35. Zimmer-Galler I, Zeimer R: Results of implementation of the DigiScope for diabetic retinopathy assessment in the primary care environment. Telemed J E Health 2006, 12:89–98.

    Article  PubMed  Google Scholar 

  36. Bursell SE, Cavallerano JD, Cavallerano AA, et al.: Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Ophthalmology 2001, 108:572–585.

    Article  PubMed  CAS  Google Scholar 

  37. Cavallerano AA, Cavallerano JD, Katalinic P, et al.: Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program. Retina 2003, 23:215–223.

    Article  PubMed  Google Scholar 

  38. Chow SP, Aiello LM, Cavallerano JD, et al.: Comparison of nonmydriatic digital retinal imaging versus dilated ophthalmic examination for nondiabetic eye disease in persons with diabetes. Ophthalmology 2006, 113:833–840.

    Article  PubMed  Google Scholar 

  39. Cavallerano JD, Aiello LP, Cavallerano AA, et al.: Nonmydriatic digital imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy. Am J Ophthalmol 2005, 140:667–673.

    Article  PubMed  Google Scholar 

  40. Conlin PR, Fisch BM, Orcutt JC, et al.: Framework for a national teleretinal imaging program to screen for diabetic retinopathy in Veterans Health Administration patients. J Rehabil Res Dev 2006, 43:741–748.

    Article  PubMed  Google Scholar 

  41. Cavallerano AA, Cavallerano JD, Katalinic P, et al.: A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center-the Joslin Vision Network Eye Health Care Model. Am J Ophthalmol 2005, 139:597–604.

    Article  PubMed  Google Scholar 

  42. Conlin PR, Fisch BM, Cavallerano AA, et al.: Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes. J Rehabil Res Dev 2006, 43:733–740.

    Article  PubMed  Google Scholar 

  43. Wilson C, Horton M, Cavallerano J, Aiello LM: Addition of primary-care based retinal imaging technology to an existing eye care professional referral program increased the rate of surveillance and treatment of diabetic retinopathy. Diabetes Care 2005, 28:318–322.

    Article  PubMed  Google Scholar 

  44. Ahmed J, Ward TP, Bursell SE, et al.: The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. Diabetes Care 2006, 29:2205–2209.

    Article  PubMed  Google Scholar 

  45. Whited JD, Datta SK, Aiello LM, et al.: A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy. Telemed J E Health 2005, 11:641–651.

    Article  PubMed  Google Scholar 

  46. Constable IJ, Yogesan K, Eikelboom R, et al.: Fred Hollows lecture: digital screening for eye disease. Clin Exp Ophthalmol 2000, 28:129–132.

    Article  CAS  Google Scholar 

  47. Hammer DX, Ferguson RD, Ustun TE, et al.: Linescanning laser ophthalmoscope. J Biomed Opt 2006, 11:411–426.

    Article  Google Scholar 

  48. Teng T, Lefley M, Claremont D: Progress towards automated diabetic ocular screening: a review of image analysis and intelligent systems for diabetic retinopathy. Med Biol Eng Comput 2002, 40:2–13.

    Article  PubMed  CAS  Google Scholar 

  49. Patton N, Aslam TM, MacGillivray T, et al.: Retinal image analysis: concepts, applications and potential. Prog Retin Eye Res 2006, 25:99–127.

    Article  PubMed  Google Scholar 

  50. Larsen N, Godt J, Grunkin M, et al.: Automated detection of diabetic retinopathy in a fundus photographic screening population. Invest Ophthalmol Vis Sci 2003, 44:767–771.

    Article  PubMed  Google Scholar 

  51. Bouhaimed M, Gibbins R, Owens D: Automated detection of diabetic retinopathy: results of a screening study. Diabetes Technol Ther 2008, 10:142–148.

    Article  PubMed  Google Scholar 

  52. Nayak J, Bhat PS, Acharya R, et al.: Automated identification of diabetic retinopathy stages using digital fundus images. J Med Syst 2008, 32:107–115.

    Article  PubMed  Google Scholar 

  53. Chaum E, Karnowski TP, Govindasamy VP, et al.: Automated diagnosis of retinopathy by content-based image retrieval. Retina 2008, 28:1463–1477.

    Article  PubMed  Google Scholar 

  54. Bronson-Castain KW, Bearse MA Jr, Neuville J, et al.: Adolescent with type 2 diabetes: early indications of focal retinal neuropathy, retinal thinning, and venular dilation. Retina 2009 (in press).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jerry D. Cavallerano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Silva, P.S., Cavallerano, J.D. & Aiello, L.M. Ocular telehealth initiatives in diabetic retinopathy. Curr Diab Rep 9, 265–271 (2009). https://doi.org/10.1007/s11892-009-0041-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-009-0041-6

Keywords

Navigation