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Bonilla-Escobar FJ, Eibel MR, Le L, Gallagher DS, Waxman EL. Follow-up in a point-of-care diabetic retinopathy program in Pittsburgh: a non-concurrent retrospective cohort study. BMC Ophthalmol 2024; 24:356. [PMID: 39164678 PMCID: PMC11334608 DOI: 10.1186/s12886-024-03581-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/17/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND The Point-of-Care Diabetic Retinopathy Examination Program (POCDREP) was initiated in 2015 at the University of Pittsburgh/UPMC in response to low diabetic retinopathy (DR) examination rates, a condition affecting a quarter of people with diabetes mellitus (PwDM) and leading to blindness. Early detection and treatment are critical with DR prevalence projected to triple by 2050. Approximately, half of PwDM in the U.S. undergo yearly examinations, and there are reported varying follow-up rates with eye care professionals, with limited data on the factors influencing these trends. POCDREP aimed to address screening and follow-up gap, partnering with diverse healthcare entities, including primary care sites, free clinics, and federally qualified health centers. METHODS A non-concurrent retrospective cohort study spanning 2015-2018 examined data using electronic health records of patients who underwent retinal imaging. Imaging was performed using 31 cameras across various settings, with results interpreted by ophthalmologists. Follow-up recommendations were made for cases with vision-threatening DR (VTDR), incidental findings, or indeterminate results. Factors influencing follow-up were analyzed, including demographic, clinical, and imaging-related variables. We assessed the findings at follow-up of patients with indeterminate results. RESULTS Out of 7,733 examinations (6,242 patients), 32.25% were recommended for follow-up. Among these, 5.57% were classified as having VTDR, 14.34% had other ocular findings such as suspected glaucoma and age-related macular degeneration (AMD), and 12.13% were indeterminate. Of those recommended for follow-up, only 30.87% were assessed by eye care within six months. Older age, marriage, and severe DR were associated with higher odds of following up. Almost two thirds (64.35%) of the patients with indeterminate exams were found with a vision-threatening disease at follow-up. CONCLUSION The six-month follow-up rate was found to be suboptimal. Influential factors for follow-up included age, marital status, and the severity of diabetic retinopathy (DR). While the program successfully identified a range of ocular conditions, screening initiatives must extend beyond mere disease detection. Ensuring patient follow-up is crucial to DR preventing programs mission. Recommended strategies to improve follow-up adherence include education, incentives, and personalized interventions. Additional research is necessary to pinpoint modifiable factors that impact adherence and to develop targeted interventions.
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Affiliation(s)
- Francisco J Bonilla-Escobar
- Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, PA, USA.
- Grupo de Investigación Visión y Salud Ocular, Servicio de Oftalmología, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO /, Science to Serve the Community Foundation, SCISCO Foundation, Cali, Colombia.
| | - Maria Regina Eibel
- Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, PA, USA
| | - Laura Le
- Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, PA, USA
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Silva PS, Cavallerano JD, Sun JK, Tolson AM, Tolls D, Abrahamson MJ, Aiello LM, Aiello LP. Disparities Between Teleretinal Imaging Findings and Patient-Reported Diabetic Retinopathy Status and Follow-up Eye Care Interval: A 10-Year Prospective Study. Diabetes Care 2024; 47:970-977. [PMID: 38457639 PMCID: PMC11116909 DOI: 10.2337/dc23-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To assess self-reported awareness of diabetic retinopathy (DR) and concordance of eye examination follow-up compared with findings from concurrent retinal images. RESEARCH DESIGN AND METHODS We conducted a prospective observational 10-year study of 26,876 consecutive patients with diabetes who underwent retinal imaging during an endocrinology visit. Awareness and concordance were evaluated using questionnaires and retinal imaging. RESULTS Awareness information and gradable images were available in 25,360 patients (94.3%). Severity of DR by imaging was as follows: no DR (n = 14,317; 56.5%), mild DR (n = 6,805; 26.8%), or vision-threatening DR (vtDR; n = 4,238; 16.7%). In the no, mild, and vtDR groups, 96.7%, 88.5%, and 54.9% of patients, respectively, reported being unaware of any prior DR. When DR was present, reporting no prior DR was associated with shorter diabetes duration, milder DR, last eye examination >1 year before, no dilation, no scheduled appointment, and less specialized provider (all P < 0.001). Among patients with vtDR, 41.2%, 58.1%, and 64.2% did not report being aware of any DR and follow-up was concordant with current DR severity in 66.7%, 41.3%, and 25.4% (P < 0.001) of patients when prior examination was performed by a retinal specialist, nonretinal ophthalmologist, or optometrist (P < 0.001), respectively. CONCLUSIONS Substantial discrepancies exist between DR presence, patient awareness, and concordance of follow-up across all DR severity levels. These discrepancies are present across all eye care provider types, with the magnitude influenced by provider type. Therefore, patient self-report should not be relied upon to reflect DR status. Modification of medical care and education models may be necessary to enhance retention of ophthalmic knowledge in patients with diabetes and ensure accurate communication between all health care providers.
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Affiliation(s)
- Paolo S. Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Jerry D. Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Ann M. Tolson
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Martin J. Abrahamson
- Adult Diabetes, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lloyd M. Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
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Au A, Bajar BT, Wong BM, Daskivich LP, Hosseini H, Prasad PS. Systemic and ocular outcomes in patients with young-onset type 2 diabetes. J Diabetes Complications 2024; 38:108670. [PMID: 38219336 DOI: 10.1016/j.jdiacomp.2023.108670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To analyze the systemic and ocular outcomes in patients with young-onset type 2 diabetes (YO-DM2) based on grade of presenting diabetic retinopathy (DR). METHODS Retrospective cohort study analysis of empaneled patients with type 2 diabetes <40 years old with retinopathy screening within the Los Angeles Department of Health Services between 01/01/2017-07/01/2021 were included. Patients were stratified based on presenting severity of DR determined on fundus photographs or clinical examination. Patient's systemic co-morbidities and ocular outcomes were then compared across each group. Procedural (e.g. intravitreal injections) and surgical interventions (e.g. pars plana vitrectomy) were documented as performed by the treating physician. RESULTS 2795 patients were screened from 12,456 patients diagnosed with diabetes younger than age 40 (22.4 %). Of these, 1496 patients were diagnosed with type 2 DM. 1084 (72.4 %) of patients presented without DR, 307 (20.5 %) presented with non-proliferative diabetic retinopathy (NPDR), and 105 (7.0 %) of patients presented with proliferative diabetic retinopathy (PDR). Increasing presenting diabetic retinopathy severity was associated with longer duration of diabetes, greater systemic comorbidities (e.g. diabetic foot disease, neuropathy, chronic kidney or end stage renal disease), worse baseline and final visual acuity, and required more procedural and surgical interventions. CONCLUSIONS Worse presenting DR severity in patients young-onset type 2 diabetes was associated with greater comorbid systemic and ocular disease with worse visual acuity outcomes. <1 % of patients without diabetic retinopathy or with mild NPDR were likely to progress to PDR. Diabetic kidney disease was an independent risk factor for developing neovascular glaucoma and retinal detachments. Prompt evaluation and intervention in patients with YO-DM2 may help reduce the associated systemic and ocular morbidity.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America; Division of Ophthalmology, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Bryce T Bajar
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Brittany M Wong
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Lauren P Daskivich
- Los Angeles County Department of Health Services, Los Angeles, CA, United States of America
| | - Hamid Hosseini
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America; Division of Ophthalmology, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Pradeep S Prasad
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America; Division of Ophthalmology, Harbor-UCLA Medical Center, Torrance, CA, United States of America.
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Alhujaili HO, Alanazi AM, Alshehri WM, Alghamdi RA, Alqasem AA, Alhumaid FI, AlGhamdi RA, Almaymuni KK. Adherence to Eye Examination Guidelines Among Individuals With Diabetes in Saudi Arabia. Cureus 2024; 16:e51472. [PMID: 38298281 PMCID: PMC10828750 DOI: 10.7759/cureus.51472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Individuals with diabetes are at risk of developing diabetic retinopathy, a vision-threatening complication. Regular eye examinations are crucial for early detection and management. Ensuring adherence to eye examination guidelines is essential to prevent visual impairment and blindness in this at-risk population. METHODS This was cross-sectional study, and a validated questionnaire was physically administered among adult individuals with diabetes (both males and females) in Saudi Arabia. The data were gathered and analyzed using Statistical Product and Service Solutions (SPSS, version 26.0) software (IBM SPSS Statistics for Windows, Armonk, NY). This study took approximately three months from the period August 2023 to November 2023. RESULTS This study found that most participants had type 1 diabetes (46.1%, n=83) and had been diagnosed for more than 10 years (49.4%, n=89). The most used management strategy (48.9%, n=88) was lifestyle changes and anti-diabetic medications. Most of the participants (93.3%, n=168) were fully aware of the severe eye complications of diabetes, as well as diabetic retinopathy and its complications (48.9%, n=88). The most common source of information about the importance of eye exams was healthcare professionals (56.7%, n=102). Most of the participants had annual eye exams (58.3%, n=105) and within the previous year, specifically related to their diabetes (62.8%, n=113). Adherence to eye examination guidelines was higher in those who had diabetes for more than 10 years (p=0.009), those who were on lifestyle changes and insulin therapy or anti-diabetic medications (p=0.030), those who were fully aware of severe eye complications and diabetic retinopathy (p=0.017 and p=0.020, respectively), and those with type 2 diabetes (p=0.001). In addition, participants who understood the importance of eye examinations had better glucose control (p=0.017), had eye examinations within the previous year (p=0.001), and had heard about the importance of eye examinations from healthcare professionals (p=0.020). The findings revealed the most common reasons for not getting an eye exam were a lack of awareness (37.8%) and distance from the hospital. CONCLUSION To summarize, many people with diabetes do not get regular eye exams often because they are unaware of how important these exams are. Long-term diabetics who are aware of the dangers of diabetic retinopathy are more likely to heed this advice. However, adherence was linked to more frequent eye exams and better glucose control. Adherence and wide awareness must be created to improve retinopathy outcomes.
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Affiliation(s)
| | | | - Waleed M Alshehri
- General Practice, King Salman Bin Abdulaziz Medical City, Madina, SAU
| | - Rayan A Alghamdi
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulmlk A Alqasem
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Jacoba CMP, Cavallerano JD, Tolston AM, Silva PS. Effect of Accessible Nonmydriatic Retinal Imaging on Diabetic Retinopathy Surveillance Rates. Telemed J E Health 2023; 29:1667-1672. [PMID: 36912812 DOI: 10.1089/tmj.2022.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Purpose: To evaluate the impact on surveillance rates for diabetic retinopathy (DR) by providing nonmydriatic retinal imaging as part of comprehensive diabetes care at no cost to patients or insurers. Methods: A retrospective comparative cohort study was designed. Patients were imaged from April 1, 2016 to March 31, 2017 at a tertiary diabetes-specific academic medical center. Retinal imaging was provided without additional cost beginning October 16, 2016. Images were evaluated for DR and diabetic macular edema using standard protocol at a centralized reading center. Diabetes surveillance rates before and after no-cost imaging were compared. Results: A total of 759 and 2,080 patients respectively were imaged before and after offering no-cost retinal imaging. The difference represents a 274% increase in the number of patients screened. Furthermore, there was a 292% and 261% increase in the number of eyes with mild DR and referable DR, respectively. In the comparative 6-month period, 92 additional cases of proliferative DR were identified, estimated to prevent 6.7 cases of severe visual loss with annual cost savings of $180,230 (estimated yearly cost of severe vision loss per person: $26,900). In patients with referable DR, self-awareness was low, with no significant difference in the before and after groups (39.4% vs. 43.8%, p = 0.3725). Conclusions: Providing retinal imaging as part of comprehensive diabetes care substantially increased the number of patients identified by nearly threefold. The data suggest that the removal of out-of-pocket costs substantially increased patient surveillance rates, which may translate to improved long-term patient outcomes.
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Affiliation(s)
- Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann M Tolston
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Pelayo C, Hoang J, Mora Pinzón M, Lock LJ, Fowlkes C, Stevens CL, Jacobson NA, Channa R, Liu Y. Perspectives of Latinx Patients with Diabetes on Teleophthalmology, Artificial Intelligence-Based Image Interpretation, and Virtual Care: A Qualitative Study. TELEMEDICINE REPORTS 2023; 4:317-326. [PMID: 37908628 PMCID: PMC10615055 DOI: 10.1089/tmr.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
Background Latinx populations in the United States bear a disproportionate burden of diabetic eye disease. Teleophthalmology with and without artificial intelligence (AI)-based image interpretation are validated methods for diabetic eye screening, but limited literature exists on patient perspectives. This study aimed at understanding the perspectives of Latinx patients with diabetes on teleophthalmology, AI-based image interpretation, and general virtual care to prevent avoidable blindness in this population. Methods We conducted semi-structured, individual interviews with 20 Latinx patients with diabetes at an urban, federally qualified health center in Madison, WI. Interviews were transcribed verbatim, professionally translated from Spanish to English, and analyzed using both inductive open coding and deductive coding. Results Most participants had no prior experience with teleophthalmology but did have experience with virtual care. Participants expressed a preference for teleophthalmology compared with traditional in-person dilated eye exams but were willing to obtain whichever method of screening was recommended by their primary care clinician. They also strongly preferred having human physician oversight in image review compared with having images interpreted solely using AI. Many participants preferred in-person clinic visits to virtual health care due to the ability to have a more thorough physical exam, as well as for improved non-verbal communication with their clinician. Discussion Leveraging primary care providers' recommendations, human oversight of AI-based image interpretation, and improving communication may enhance acceptance and utilization of teleophthalmology, AI, and virtual care by Latinx patients. Conclusions Understanding Latinx patient perspectives may contribute toward the development of more effective telemedicine interventions to enhance health equity in Latinx communities.
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Affiliation(s)
- Christian Pelayo
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Johnson Hoang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maria Mora Pinzón
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Loren J. Lock
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christiana Fowlkes
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Chloe L. Stevens
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nora A. Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- School of Nursing, Madison, Wisconsin, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Scanzera AC, Sherrod RM, Potharazu AV, Nguyen D, Beversluis C, Karnik NS, Chan RVP, Kim SJ, Krishnan JA, Musick H. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol 2023; 12:11. [PMID: 37831446 PMCID: PMC10587857 DOI: 10.1167/tvst.12.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose To explore barriers and facilitators to completing scheduled outpatient appointments at an urban academic hospital-based ophthalmology department. Methods Potential participants were stratified by neighborhood Social Vulnerability Index (SVI) (range, 0-1.0, higher scores indicate greater vulnerability), and semistructured interviews were conducted with individuals 18 years and older with an SVI of greater than 0.61 (n = 17) and providers delivering care in the General Eye Clinic of the University of Illinois Chicago (n = 8). Qualitative analysis informed by human-centered design methods was conducted to classify barriers and facilitators into three domains of the Consolidated Framework for Implementation Research: outer setting, inner setting, and characteristics of individuals. Results There were four main themes-transportation, time burden, social support, and economic situation-all of which were within the outer setting of the Consolidated Framework for Implementation Research; transportation was most salient. Although providers perceived health literacy as a barrier affecting motivation, patients expressed a high motivation to attend visits and felt well-educated about their condition. Conclusions A lack of resources outside of the health system presents significant barriers for patients from neighborhoods with high SVI. Future efforts to improve adherence should focus on resource-related interventions in the outer setting. Improving access to eye care will require community-level interventions, particularly transportation. Translational Relevance Understanding the barriers and facilitators within the Consolidated Framework for Implementation Research provides useful guidance for future interventions, specifically to focus future efforts to improve adherence on resource-related interventions.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - R. McKinley Sherrod
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Diana Nguyen
- Institute of Design, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Niranjan S. Karnik
- Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robison V. P. Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sage J. Kim
- Division of Health Policy, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
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Davis M, Snider MJE, Hunt KJ, Medunjanin D, Neelon B, Maa AY. Geographic variation in diabetic retinopathy screening within the Veterans Health Administration. Prim Care Diabetes 2023; 17:429-435. [PMID: 37419770 DOI: 10.1016/j.pcd.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
AIMS Diabetic retinopathy (DR) remains the leading cause of vision impairment among working-age adults in the United States. The Veterans Health Administration (VA) supplemented its DR screening efforts with teleretinal imaging in 2006. Despite its scale and longevity, no national data on the VA's screening program exists since 1998. Our objective was to determine the influence of geography on diabetic retinopathy screening adherence. METHODS Setting: VA national electronic medical records. STUDY POPULATION A national cohort of 940,654 veterans with diabetes (defined as two or more diabetes ICD-9 codes (250.xx)) without a history of DR. EXPOSURES 125 VA Medical Center catchment areas, demographics, comorbidity burden, mean HbA1c levels, medication use and adherence, as well as utilization and access metrics. MAIN OUTCOME MEASURE Screening for diabetic retinopathy within the VA medical system within a 2-year period. RESULTS Within a 2-year time frame 74 % of veterans without a history of DR received retinal screenings within the VA system. After adjustment for age, gender, race-ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of DR screening varied by VA catchment area with values ranging from 27 % to 86 %. These differences persisted after further adjusting for mean HbA1c level, medication use and adherence as well as utilization and access metrics. CONCLUSIONS The wide variability in DR screening across 125 VA catchment areas indicates the presence of unmeasured determinants of DR screening. These results are relevant to clinical decision making in DR screening resource allocation.
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Affiliation(s)
- Melanie Davis
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | | | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA; Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, 29425, USA
| | - Danira Medunjanin
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, 29425, USA
| | - Brian Neelon
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA; Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, 29425, USA
| | - April Y Maa
- Emory University School of Medicine, Atlanta, GA, 30322, USA; VISN 7, Regional Telehealth Services, Atlanta Veterans Affairs Medical Center, Atlanta, GA, 30033, USA
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Andoh JE, Ezekwesili AC, Nwanyanwu K, Elam A. Disparities in Eye Care Access and Utilization: A Narrative Review. Annu Rev Vis Sci 2023; 9:15-37. [PMID: 37254050 DOI: 10.1146/annurev-vision-112122-020934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Agnes C Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela Elam
- Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA;
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Alqahtani TF, Alqarehi R, Mulla OM, Alruwais AT, Alsaadi SS, Algarni H, Elhams YM, Alkalash S. Knowledge, Attitude, and Practice Regarding Diabetic Retinopathy Screening and Eye Management Among Diabetics in Saudi Arabia. Cureus 2023; 15:e46190. [PMID: 37905261 PMCID: PMC10613343 DOI: 10.7759/cureus.46190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Background Globally, one of the leading causes of blindness is diabetic retinopathy (DR). However, many patients do not participate in DR screening because of a lack of awareness. This study aims to assess the knowledge, attitude, and practice (KAP) level regarding DR screening and eye management among diabetic patients in Saudi Arabia. Methodology This cross-sectional study was conducted among diabetic patients aged 18 years or older in Saudi Arabia between October 2022 and February 2023. A validated online KAP-36 questionnaire collected information on sociodemographic data, diabetes profile, diabetes-related complications, and KAP regarding DR screening and management. Results Of the 1,391 diabetic patients, 736 (52.9%) had good knowledge about DR screening and care, while 655 (47.1%) had poor knowledge. A positive attitude toward eye examination for the early detection of DR was noticed among 1,124 (80.8%) participants. Regarding the participants' practice of regular fundus examination, 1,000 (71.9%) participants had good practice. Significant relationships were found between education level (p = 0.017), diabetes mellitus (DM) type and duration (p= 0.01, 0.02), type of treatment (p = 0.001), and a high degree of knowledge. Significant determinants of patients' favorable attitudes included their type of diabetes (p = 0.003), region of residence (p = 0.038), and work or education outside the medical field (p = 0.001). Age (p = 0.001), location of residence (p = 0.015), educational attainment (p= 0.041), and type of diabetes (p = 0.045) were the factors that determined good practice. Conclusions Many diabetic patients supported DR screening and engaged in it regularly. Unfortunately, only around half of the participants had a good understanding of DR. Type 2 diabetes mellitus (T2DM), a longer history of DM, and being highly educated were factors associated with a diabetic patient's higher level of knowledge. Positive attitudes were significantly higher among those living in the central Saudi region, employed outside of the medical field, and those with T2DM. Finally, regarding the practice of eye screening and management among diabetic patients, elderly patients living in the southern Saudi region and those with T2DM were adherent to their regular eye examinations. Consequently, the key to ensuring adequate adherence to DR screening may be intervention techniques and focused education to increase patients' knowledge of DR.
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Affiliation(s)
| | - Rahaf Alqarehi
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Oyoon M Mulla
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | | | - Hajar Algarni
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Safa Alkalash
- Family Medicine, Menoufia University, Shibin el Kom, EGY
- Community and Primary Care, Umm Al-Qura University, Al-Qunfudah, SAU
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11
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Xiao B, Gu X, Jin L, Chan VF, Li Y, Price-Sanchez C, Liu Y, Wang Y, Fu H, Li D, Congdon N. Willingness to pay for diabetic retinopathy screening in Qujiang District, rural Guangdong, southern China: a cross-sectional study. BMJ Open 2023; 13:e065792. [PMID: 37185202 PMCID: PMC10151899 DOI: 10.1136/bmjopen-2022-065792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To determine willingness to pay for a diabetic retinopathy screening, and its determinants, among people with diabetes mellitus in Qujiang District of Shaoguan City, rural Guangdong, southern China. DESIGN This cross-sectional study was conducted through a large-scale screening programme in 2019. We randomly selected 575 (21.5%) among 2677 people over 18 years old with known diabetes who attended the screening. Participants elected to pay nothing or RMB10-RMB120 (US$1.6-US$18.8), in RMB10 intervals, displayed on printed cards. One trained interviewer collected all the data. SETTING Ten primary health centres in Qujiang District of Shaoguan City, Guangdong. PARTICIPANTS 545 from the 575 randomly selected people (94.8%) agreed to participate in the study. OUTCOME MEASURES Proportion of participants willing to pay anything for screening, mean amount they were willing to pay and determinants of these figures. RESULTS Among 545 participants (mean age 64.6 years (SD±10.4), 40.7% men), 327 (60.0%) were willing to pay something for screening, of whom 273 (83.5%) would pay RMB10-RMB30 (US$1.6-US$4.7). People living in rural areas and those from lower-income families were more likely to be willing to pay anything, while men, urban residents and those covered by employer-linked insurance were willing to pay larger sums (p<0.05 for all). CONCLUSION Nearly two-thirds of participants were willing to pay for screening in this screening programme organised at the primary care level in rural China. This finding offers the potential that such activities can be sustained and scaled up through user fees.
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Affiliation(s)
- Baixiang Xiao
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
| | - Xuejun Gu
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Ling Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ving Fai Chan
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Yanping Li
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | | | - Yuanping Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yanfang Wang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haoxiang Fu
- Zhenjiang District Hospital, Shaoguan, Guangdong Province, China
| | - Dongfeng Li
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
| | - Nathan Congdon
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Orbis International, NY, New York, USA
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12
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Elafros MA, Callaghan BC, Skolarus LE, Vileikyte L, Lawrenson JG, Feldman EL. Patient and health care provider knowledge of diabetes and diabetic microvascular complications: a comprehensive literature review. Rev Endocr Metab Disord 2023; 24:221-239. [PMID: 36322296 PMCID: PMC10202021 DOI: 10.1007/s11154-022-09754-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
Diabetic retinopathy, neuropathy, and nephropathy occur in more than 50% of people with diabetes, contributing substantially to morbidity and mortality. Patient understanding of these microvascular complications is essential to ensure early recognition and treatment of these sequalae as well as associated symptoms, yet little is known about patient knowledge of microvascular sequalae. In this comprehensive literature review, we provide an overview of existing knowledge regarding patient knowledge of diabetes, retinopathy, neuropathy, and nephropathy. We also discuss health care provider's knowledge of these sequalae given that patients and providers must work together to achieve optimal care. We evaluated 281 articles on patient and provider knowledge of diabetic retinopathy, neuropathy, and nephropathy as well as predictors of improved knowledge and screening practices. Results demonstrated that patient and provider knowledge of microvascular sequalae varied widely between studies, which may reflect sociocultural or methodologic differences. Knowledge assessment instruments varied between studies with limited validation data and few studies controlled for confounding. Generally, improved patient knowledge was associated with greater formal education, longer diabetes duration, and higher socioeconomic status. Fewer studies examined provider knowledge of sequalae, yet these studies identified multiple misconceptions regarding appropriate screening practices for microvascular complications and the need to screen patients who are asymptomatic. Further investigations are needed that use well validated measures, control for confounding, and include diverse populations. Such studies will allow identification of patients and providers who would benefit from interventions to improve knowledge of microvascular complications and, ultimately, improve patient outcomes.
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Affiliation(s)
| | | | - Lesli E Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Loretta Vileikyte
- Division of Diabetes, Endocrinology, and Gastroenterology, University of Manchester, Manchester, UK
- Department of Endocrinology and Dermatology, University of Miami, Miami, FL, USA
| | - John G Lawrenson
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
- Department of Neurology, Michigan Medicine, University of Michigan, 48109, Ann Arbor, MI, USA.
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13
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Schofield T, Patel A, Palko J, Ghorayeb G, Laxson LC. Diabetic retinopathy screenings in West Virginia: an assessment of teleophthalmology implementation. BMC Ophthalmol 2023; 23:93. [PMID: 36899342 PMCID: PMC9999538 DOI: 10.1186/s12886-023-02833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The prevalence of diabetes in the state of West Virginia (WV) is amongst the highest in the United States, making diabetic retinopathy (DR) and diabetic macular edema (DME) a major epidemiological concern within the state. Several challenges exist regarding access to eye care specialists for DR screening in this rural population. A statewide teleophthalmology program has been implemented. We analyzed real-world data acquired via these systems to explore the concordance between image findings and subsequent comprehensive eye exams and explore the impact of age on image gradeability and patient distance from the West Virginia University (WVU) Eye Institute on follow-up. METHODS Nonmydriatic fundus images of diabetic eyes acquired at primary care clinics throughout WV were reviewed by retina specialists at the WVU Eye Institute. Analysis included the concordance between image interpretations and dilated examination findings, hemoglobin A1c (HbA1c) levels and DR presence, image gradeability and patient age, and distance from the WVU Eye Institute and follow-up compliance. RESULTS From the 5,512 fundus images attempted, we found that 4,267 (77.41%) were deemed gradable. Out of the 289 patients whose image results suggested DR, 152 patients (52.6%) followed up with comprehensive eye exams-finding 101 of these patients to truly have DR/DME and allowing us to determine a positive predictive value of 66.4%. Patients within the HbA1c range of 9.1-14.0% demonstrated significantly greater prevalence of DR/DME (p < 0.01). We also found a statistically significant decrease in image gradeability with increased age. When considering distance from the WVU Eye Institute, it was found that patients who resided within 25 miles demonstrated significantly greater compliance to follow-up (60% versus 43%, p < 0.01). CONCLUSIONS The statewide implementation of a telemedicine program intended to tackle the growing burden of DR in WV appears to successfully bring concerning patient cases to the forefront of provider attention. Teleophthalmology addresses the unique rural challenges of WV, but there is suboptimal compliance to essential follow-up with comprehensive eye exams. Obstacles remain to be addressed if these systems are to effectively improve outcomes in DR/DME patients and diabetic patients at risk of developing these sight-threatening pathologies.
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Affiliation(s)
- Travis Schofield
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.
| | - Ami Patel
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Joel Palko
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Ghassan Ghorayeb
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - L Carol Laxson
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
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14
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Peeters F, Rommes S, Elen B, Gerrits N, Stalmans I, Jacob J, De Boever P. Artificial Intelligence Software for Diabetic Eye Screening: Diagnostic Performance and Impact of Stratification. J Clin Med 2023; 12:jcm12041408. [PMID: 36835942 PMCID: PMC9967595 DOI: 10.3390/jcm12041408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
AIM To evaluate the MONA.health artificial intelligence screening software for detecting referable diabetic retinopathy (DR) and diabetic macular edema (DME), including subgroup analysis. METHODS The algorithm's threshold value was fixed at the 90% sensitivity operating point on the receiver operating curve to perform the disease classification. Diagnostic performance was appraised on a private test set and publicly available datasets. Stratification analysis was executed on the private test set considering age, ethnicity, sex, insulin dependency, year of examination, camera type, image quality, and dilatation status. RESULTS The software displayed an area under the curve (AUC) of 97.28% for DR and 98.08% for DME on the private test set. The specificity and sensitivity for combined DR and DME predictions were 94.24 and 90.91%, respectively. The AUC ranged from 96.91 to 97.99% on the publicly available datasets for DR. AUC values were above 95% in all subgroups, with lower predictive values found for individuals above the age of 65 (82.51% sensitivity) and Caucasians (84.03% sensitivity). CONCLUSION We report good overall performance of the MONA.health screening software for DR and DME. The software performance remains stable with no significant deterioration of the deep learning models in any studied strata.
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Affiliation(s)
- Freya Peeters
- Department of Ophthalmology, University Hospitals Leuven, 3000 Leuven, Belgium
- Biomedical Sciences Group, Research Group Ophthalmology, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Stef Rommes
- MONA.health, 3060 Bertem, Belgium
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Bart Elen
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Nele Gerrits
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals Leuven, 3000 Leuven, Belgium
- Biomedical Sciences Group, Research Group Ophthalmology, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Julie Jacob
- Department of Ophthalmology, University Hospitals Leuven, 3000 Leuven, Belgium
- Biomedical Sciences Group, Research Group Ophthalmology, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Patrick De Boever
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, 3500 Hasselt, Belgium
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15
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Harmon J, Kelly S, Acheson R, Keegan D, McMahon S, Kavanagh H, O’Toole L. The Effect on Patients' Visual Acuity and Grade, Secondary to Non-Attendance at Treatment Centers, Post Referral from Diabetic RetinaScreen Ireland. Clin Ophthalmol 2023; 17:183-190. [PMID: 36660306 PMCID: PMC9843507 DOI: 10.2147/opth.s388988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background Patient non-attendance following referral to hospital is a significant challenge, in particular, for persons with diabetes. Aim We sought to determine the impact on both visual acuity and the subsequent follow-up retinopathy grade of patients when they fail to attend Diabetic Retinopathy Treatment (DRT) Centers following referral from Diabetic RetinaScreen (DRS). Methods A retrospective analysis of patients discharged from DRT due to multiple consecutive missed appointments between January 2016 and June 2021. Patients discharged for non-attendance were compared with patients discharged from completed treatment. Results Of the 24,945 NEC patients referred to DRT, 5900 (24%) and 9345 (37%) were discharged back to DRS due to non-attendance and completed treatment, respectively. Those discharged for non-attendance were younger (60.7 v 63.4, p < 0.001) and had higher proportions of males (67% v 63%, p < 0.001) and people with type 1 diabetes (27% v 18%, p < 0.001). After attending rescreening after discharge, those discharged for non-attendance were significantly more likely to have a worsening of DR grade (26% v 8%, p < 0.001). Conclusion Despite being notified that further investigation (with possible treatment) was required post DRS, many diabetic patients failed to attend for further management of their eye care in DRT. These patients had worse visual outcomes compared to those that attended. Improved patient education and communication are required to mitigate against the consequences of non-attendance.
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Affiliation(s)
| | - Stephen Kelly
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | | | - David Keegan
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | | | - Helen Kavanagh
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | - Louise O’Toole
- NEC Care, Cork, Ireland,Correspondence: Louise O’Toole, NEC Care, 55 South Mall (2nd Floor), Cork, T12 RR44, Ireland, Tel +35318858656, Fax +35318858658, Email
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16
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Awareness and knowledge of glaucoma among visitors of main public hospitals in Damascus, Syria: a cross-sectional study. BMC Ophthalmol 2023; 23:17. [PMID: 36627615 PMCID: PMC9830819 DOI: 10.1186/s12886-022-02766-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The main way to prevent blindness from Glaucoma is by early detection and diagnosis; and to do so the awareness must be raised among people where Glaucoma is defined as an acquired chronic optic neuropathy characterized by optic disk cupping and visual field loss. Lack of knowledge about this disease is one of the most important reasons that made it develop to advanced stages. Based on that, we conducted scientific research to assess peoples' awareness and knowledge about Glaucoma. After reviewing the literature, it was found that this study is the first in Syria. METHODS We conducted a cross-sectional study in May 2022. The study included participants, who are above 20 years old, from visitors of Al-Mouwasat University Hospital in Damascus, Syria. During one week, Data was gathered according to the questionnaire, which was presented through face-to-face interviews with participants. We have allocated one point (1) to each question. Three levels of knowledge were adopted, namely; weak level from (0) to (3), average level from (4) to (7) and good level from (8) to (11). Associations between participants' demographic and other details were tested using Chi-square test and other tests, and a p-value of < 0.05 was considered significant. RESULTS A total of 500 participants were interviewed. For awareness of Glaucoma, 33.6% of the participants (n = 168) had heard of Glaucoma, and 66.4% hadn't (n = 332). Mean test results for the knowledge of Glaucoma was 1.62 out of 11, and only 8% of participants (n = 40) had a good knowledge of Glaucoma. Education Level, governorate, and department of hospital that the patient came for significantly affected the knowledge of Glaucoma. Moreover, hospital, Ophthalmologists' Clinics, and health staff (M = 5.45) were the better Resource for information than family, relatives, and friends (M = 3.16). Finally, social media and the Internet group had the lowest mean test results (M = 1.23). These test results were significant, with a p-value < 0.001. CONCLUSION The percentage of knowledge and awareness was significantly low. Organized community awareness methods must disseminate more ability to increase the general public's understanding to avoid injury and late diagnosis of Glaucoma.
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17
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Iskander M, Hu G, Coulon S, Seixas AA, McGowan R, Al-Aswad LA. Health literacy and ophthalmology: A scoping review. Surv Ophthalmol 2023; 68:78-103. [PMID: 35995252 DOI: 10.1016/j.survophthal.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
As of 2020, it is estimated that 43.3 million people are blind, and an additional 553 million have mild to severe vision impairment.50 At least 1 billion worldwide have a vision impairment that could have been prevented or has yet to be addressed.54 Poor health literacy may be a significant contributor to the prevalence of eye disease. With implications on disease burden, progression, and health outcomes, a greater understanding of the role health literacy plays in ophthalmology is needed. This is the first scoping review to assess the impact of health literacy on eye health outcomes and blindness, including ocular screening rates and/or follow-up rates, treatment adherence, and self-care practices. PubMed, Embase, and CINAHL databases were searched systematically through November 12, 2021, and we evaluated the association between health literacy and ophthalmic outcomes in 4 domains: clinical outcomes, treatment adherence rates, screening and/or follow-up rates, and self-care practices. There is evidence to suggest that health literacy is associated with ophthalmic outcomes in all these domains. To better understand how health literacy impacts eye health, further longitudinal studies examining the effect of health literacy (using standardized health literacy measures) on ophthalmic outcomes are needed. We believe a specific ophthalmic health literacy survey could help achieve this goal and help target interventions to ultimately improve outcomes among ophthalmology patients.
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Affiliation(s)
- Mina Iskander
- Department of Medicine, University of Miami/Jackson Health System; Department of Ophthalmology, New York University, Grossman School of Medicine
| | - Galen Hu
- Department of Ophthalmology, New York University, Grossman School of Medicine
| | - Sara Coulon
- Department of Ophthalmology, New York University, Grossman School of Medicine
| | - Azizi A Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | | | - Lama A Al-Aswad
- Department of Ophthalmology, New York University, Grossman School of Medicine; Department of Population Health, New York University, Grossman School of Medicine.
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18
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Soleimani M, Alipour F, Taghavi Y, Fatemipour M, Hakimi H, Jamali Z, Khalili P, Ayoobi F, Sheikh M, Tavakoli R, Zand A. Single-Field Fundus Photography for Screening of Diabetic Retinopathy: The Prevalence and Associated Factors in a Population-Based Study. Diabetes Ther 2023; 14:205-217. [PMID: 36480099 PMCID: PMC9880134 DOI: 10.1007/s13300-022-01348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION We aimed to determine the prevalence and risk factors for diabetic retinopathy (DR) in a multi-primary healthcare facilities-based DR screening project by analyzing single-field fundus photographs among patients with diabetes in Rafsanjan City, Iran, based on the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN). METHODS Of all participants in the Rafsanjan Cohort Study (performed in four primary healthcare facilities across Rafsanjan City from August 2015 to December 2017), patients with diabetes were recruited in this study. All participants underwent a standardized interview and clinical and paraclinical examinations for demographic characteristics, and medical conditions according to the PERSIAN's protocols. In addition, digital fovea-centered and single-field fundus photography was performed for DR identification and grading. For assessment of agreement, a subgroup of participants underwent fundus examination, randomly. DR was graded as nonproliferative (NPDR) or proliferative (PDR). RESULTS Of 8414 screened participants, 1889 had diabetes. The total prevalence of DR was 6.93% [131 individuals including 110 (5.82%) with NPDR, and 21 (1.11%) with PDR] based on single-field fundus photographs, with almost perfect agreement with fundus examinations (κ = 0.82). On adjusted multivariate analysis, duration of diabetes (OR 1.16, 95% CI 1.13-1.19), positive family history for diabetes (OR 1.73, 95% CI 1.09-2.75), fasting plasma glucose (FPG) ≥ 126 mg/dL (OR 1.98, 95% CI 1.16-3.39), and serum creatinine level (OR 1.79, 95% CI 1.08-2.98) were associated with DR. Factors including age, education level, physical activity, body mass index, hypertension, and cardiovascular and renal diseases did not have association with DR on adjusted multivariate analysis. CONCLUSIONS Single-field fundus photography can be used for screening of DR in primary healthcare facilities. In individuals with diabetes, duration of diabetes, positive family history for diabetes, FPG ≥ 126 mg/dL, and serum creatinine level may be associated with DR.
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Affiliation(s)
- Mohammadreza Soleimani
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Taghavi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marjan Fatemipour
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamid Hakimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Jamali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Parvin Khalili
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Sheikh
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Roya Tavakoli
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amin Zand
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Al-Shehri AM, Aldihan KA, Aljohani S. Reasons for the Late Presentation of Diabetic Retinopathy in Saudi Arabia: A Survey of Patients Who Presented with Advanced Proliferative Diabetic Retinopathy to a Tertiary Eye Hospital. Clin Ophthalmol 2022; 16:4323-4333. [PMID: 36597470 PMCID: PMC9805731 DOI: 10.2147/opth.s394146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to understand the barriers that contribute to diagnostic and therapeutic delays in patients with advanced proliferative diabetic retinopathy (PDR). Patients and Methods This cross-sectional study targeted patients with advanced PDR who never received any ocular intervention at King Khaled Eye Specialist Hospital in Saudi Arabia. An Arabic-language questionnaire was used to interview the participants over a period of 6 months. The questionnaire comprised sociodemographic questions followed by several sections to assess the causes of delay in diagnosis and management. Variables were analyzed descriptively and reported as numbers and percentages using SPSS 22. Results A total of 338 patients were included in the study. Most patients were older than 50 years (60.4%), and decreased vision was the main complaint at presentation (81%). Vitreous hemorrhage was the most common diagnosis (46%). Patients' lack of knowledge about the importance of DR screening programs and problems with healthcare system screenings were the most frequent causes of delay in diabetic retinopathy (DR) diagnosis and management. Conclusion DR is still a major cause of permanent blindness that is treatable with regular follow-up and timely management. Even though DR screening and treatment in Saudi Arabia have improved drastically over the last years, socioeconomic and health system factors remain barriers to the improvement of outcomes of DR.
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Affiliation(s)
- Abdulaziz Mohammed Al-Shehri
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Surgery Department, Taif University, Taif, Saudi Arabia,Correspondence: Abdulaziz Mohammed Al-Shehri, Vitreoretinal Division, King Khaled Eye Specialist Hospital, 2867 Al Urubah Road, 8247, Riyadh, 26524, Saudi Arabia, Tel +966569974474, Email
| | - Khalid Abdulaziz Aldihan
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Saud Aljohani
- Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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20
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Nourinia R, Dastmardi M, Dastmardi M, Azimi R, Hassanpour K. The diagnostic characteristics of direct ophthalmoscopy for diabetic retinopathy screening by family physicians. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Zhou Y, Li X, Sun Q, Wei J, Liu H, Wang K, Luo J. Adherence to Annual Fundus Exams among Chinese Population with Diagnosed Diabetes. J Clin Med 2022; 11:jcm11226859. [PMID: 36431336 PMCID: PMC9697630 DOI: 10.3390/jcm11226859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range of data every 2 years, including demographic, socioeconomic, medical and lifestyle-related information. The adherence rates to annual fundus exams across four waves (2011−2018) were assessed. Univariate and multivariable logistic regressions were used to determine factors associated with adherence. The adherence rates to annual fundus examinations of ou study population were 23.6% in 2011, 15.3% in 2013, 17.5% in 2015 and 21.5% in 2018, respectively. Consistent results over four waves showed that non-adherent patients had a relatively lower educational level, insufficient diabetes medication use, fewer non-medication treatments and irregular physical examination compared to those who were adherent to the annual fundus exam (all p values < 0.05). These variables were further identified as factors associated with adherence according to univariate and multivariate logistic regression analyses (all p values < 0.05). The present study provides explicit evidence that the adherence rate to annual fundus examinations among Chinese population with diabetes is worryingly low. Insufficient educational attainment, especially specific diabetes education, has a negative impact on patients’ adherence to clinical guideline for eye health.
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Affiliation(s)
- Yifan Zhou
- Department of Ophthalmology, Putuo People’s Hospital, Tongji University, Shanghai 200060, China
| | - Xiaowen Li
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Qinglei Sun
- Department of Ophthalmology, Shanghai East Hospital, Shanghai 200120, China
| | - Jin Wei
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai JiaoTong University, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai JiaoTong University, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
| | - Keyan Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Correspondence: (K.W.); (J.L.)
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
- Correspondence: (K.W.); (J.L.)
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22
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Afarid M, Mahmoodi S, Baghban R. Recent achievements in nano-based technologies for ocular disease diagnosis and treatment, review and update. J Nanobiotechnology 2022; 20:361. [PMID: 35918688 PMCID: PMC9344723 DOI: 10.1186/s12951-022-01567-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Ocular drug delivery is one of the most challenging endeavors among the various available drug delivery systems. Despite having suitable drugs for the treatment of ophthalmic disease, we have not yet succeeded in achieving a proper drug delivery approach with the least adverse effects. Nanotechnology offers great opportunities to overwhelm the restrictions of common ocular delivery systems, including low therapeutic effects and adverse effects because of invasive surgery or systemic exposure. The present review is dedicated to highlighting and updating the recent achievements of nano-based technologies for ocular disease diagnosis and treatment. While further effort remains, the progress illustrated here might pave the way to new and very useful ocular nanomedicines.
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Affiliation(s)
- Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Mahmoodi
- Department of Medical Biotechnology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Roghayyeh Baghban
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ashraf M, Hock KM, Cavallerano JD, Wang FL, Silva PS. Comparison of Widefield Laser Ophthalmoscopy and ETDRS Retinal Area for Diabetic Retinopathy. OPHTHALMOLOGY SCIENCE 2022; 2:100190. [PMID: 36531579 PMCID: PMC9754965 DOI: 10.1016/j.xops.2022.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 02/02/2023]
Abstract
Purpose To evaluate agreement of nonmydriatic confocal scanning laser ophthalmoscopy (SLO; EIDON [CenterVue]) and the 7-standard field ETDRS area on ultrawide-field (UWF) SLO imaging for identification of diabetic retinopathy (DR) severity. Design Single-site, prospective, comparative, instrument validation study. Participants One hundred ten eyes of 55 patients with diabetes mellitus were evaluated. Methods Each patient underwent nonmydriatic, nonsimultaneous stereoscopic imaging using the EIDON camera and 4 fields of 60° × 55° were acquired (macula centered, disc centered, temporal macula, superotemporal). Mydriatic UWF retinal images were acquired using a nonsimultaneous stereographic protocol with UWF imaging (California; Optos plc). Before grading, a standardized ETDRS 7-field image mask was applied to all UWF retinal images. Images from each device were graded independently by 2 masked graders using the ETDRS clinical DR classification. Any discrepancy in DR grading between the devices was adjudicated by a third grader. Main Outcome Measures κ Levels of agreement, sensitivity, and specificity for DR thresholds. Results Severity by ETDRS grading was as follows: no DR, 10.9%; mild nonproliferative DR (NPDR), 45.5%; moderate NPDR, 16.5%; severe NPDR, 11.8%; proliferative DR, 12.7%; high-risk proliferative DR, 2.7%; and ungradable, 0%. After adjudication, the level of DR identified on EIDON images agreed exactly with that of UWF ETDRS imaging in 87% of eyes (n = 96) and was within 1 step in 99.1% of eyes (n = 109) with a simple κ value of 0.8244 ± 0.0439 (95% confidence interval [CI], 0.7385-0.9104) and weighted (linear) κ value of 0.9041 ± 0.0257 (95% CI, 0.8537-0.9545). Sensitivity and specificity compared with ETDRS field grading for any DR were 0.96 and 0.75, for moderate NPDR or worse were 0.96 and 0.97, and for severe NPDR or worse were 0.91 and 1.00, respectively. Conclusions Nonmydriatic 4-field stereoscopic widefield imaging using the EIDON device was comparable with the DR severity identified within the ETDRS 7-standard field area of UWF images. Future studies will need to evaluate the applicability of this device as a clinical and research tool and the impact of different widefield coverage areas.
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Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Kristen M. Hock
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Jerry D. Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Frank L. Wang
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Paolo S. Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Correspondence: Paolo S. Silva, MD, Beetham Eye Institute, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215.
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Yuen J, Pike S, Khachikyan S, Nallasamy S. Telehealth in Ophthalmology. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-telehealth-ophthalmology] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Hudson SM, Modjtahedi BS, Altman D, Jimenez JJ, Luong TQ, Fong DS. Factors Affecting Compliance with Diabetic Retinopathy Screening: A Qualitative Study Comparing English and Spanish Speakers. Clin Ophthalmol 2022; 16:1009-1018. [PMID: 35400992 PMCID: PMC8992739 DOI: 10.2147/opth.s342965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sharon M Hudson
- Keck School of Medicine of USC/Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Bobeck S Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Correspondence: Bobeck S Modjtahedi, Eye Monitoring Center, Kaiser Permanente Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA, Email
| | - Danielle Altman
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Tiffany Q Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Donald S Fong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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26
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Racial disparities in the screening and treatment of diabetic retinopathy. J Natl Med Assoc 2022; 114:171-181. [DOI: 10.1016/j.jnma.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
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27
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Wang Y, Shi D, Tan Z, Niu Y, Jiang Y, Xiong R, Peng G, He M. Screening Referable Diabetic Retinopathy Using a Semi-automated Deep Learning Algorithm Assisted Approach. Front Med (Lausanne) 2021; 8:740987. [PMID: 34901058 PMCID: PMC8656222 DOI: 10.3389/fmed.2021.740987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose: To assess the accuracy and efficacy of a semi-automated deep learning algorithm (DLA) assisted approach to detect vision-threatening diabetic retinopathy (DR). Methods: We developed a two-step semi-automated DLA-assisted approach to grade fundus photographs for vision-threatening referable DR. Study images were obtained from the Lingtou Cohort Study, and captured at participant enrollment in 2009–2010 (“baseline images”) and annual follow-up between 2011 and 2017. To begin, a validated DLA automatically graded baseline images for referable DR and classified them as positive, negative, or ungradable. Following, each positive image, all other available images from patients who had a positive image, and a 5% random sample of all negative images were selected and regraded by trained human graders. A reference standard diagnosis was assigned once all graders achieved consistent grading outcomes or with a senior ophthalmologist's final diagnosis. The semi-automated DLA assisted approach combined initial DLA screening and subsequent human grading for images identified as high-risk. This approach was further validated within the follow-up image datasets and its time and economic costs evaluated against fully human grading. Results: For evaluation of baseline images, a total of 33,115 images were included and automatically graded by the DLA. 2,604 images (480 positive results, 624 available other images from participants with a positive result, and 1500 random negative samples) were selected and regraded by graders. The DLA achieved an area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy of 0.953, 0.970, 0.879, and 88.6%, respectively. In further validation within the follow-up image datasets, a total of 88,363 images were graded using this semi-automated approach and human grading was performed on 8975 selected images. The DLA achieved an AUC, sensitivity, and specificity of 0.914, 0.852, 0.853, respectively. Compared against fully human grading, the semi-automated DLA-assisted approach achieved an estimated 75.6% time and 90.1% economic cost saving. Conclusions: The DLA described in this study was able to achieve high accuracy, sensitivity, and specificity in grading fundus images for referable DR. Validated against long-term follow-up datasets, a semi-automated DLA-assisted approach was able to accurately identify suspect cases, and minimize misdiagnosis whilst balancing safety, time, and economic cost.
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Affiliation(s)
- Yueye Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danli Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zachary Tan
- Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
| | - Yong Niu
- Department of Ophthalmology, Guangzhou No. 11 People's Hospital, Guangzhou, China
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Guankai Peng
- Guangzhou Vision Tech Medical Technology Co. Ltd., Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.,Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
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Abstract
ABSTRACT Diabetic retinopathy (DR) is an important cause of blindness globally, and its prevalence is increasing. Early detection and intervention can help change the outcomes of the disease. The rapid development of artificial intelligence (AI) in recent years has led to new possibilities for the screening and diagnosis of DR. An AI-based diagnostic system for the detection of DR has significant advantages, such as high efficiency, high accuracy, and lower demand for human resources. At the same time, there are shortcomings, such as the lack of standards for development and evaluation and the limited scope of application. This article demonstrates the current applications of AI in the field of DR, existing problems, and possible future development directions.
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Affiliation(s)
- Sicong Li
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | | | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
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Alamri A, Al-Jahash NAS, Alsultan MSH, AlQahtani SSA, Saeed YAA, Alhamlan RAO. Awareness, knowledge, and practice regarding to diabetic retinopathy among KKU students besides medical students in Abha, Saudi Arabia. J Family Med Prim Care 2021; 10:3233-3239. [PMID: 34760736 PMCID: PMC8565152 DOI: 10.4103/jfmpc.jfmpc_86_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Diabetes mellitus (DM) is a global public health problem. Global prevalence of diabetes is 8.5% in adult population. The prevalence of diabetic retinopathy (DR) is increasing day by day, the number of persons with diabetes will double by 2030. It is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. This study's intent to estimate and improve level of awareness (A), knowledge (K), and practice (P) among all King Khalid University (KKU) students besides medical students in Abha, Saudi Arabia. Methods and Materials: This is a cross-sectional survey that targets all KKU students besides medical students in Abha, Saudi Arabia. The researchers will use closed-end questions for awareness (A), knowledge (K), and practice (P). The data and the questionnaires will be sent to the sample by social media. The data will be analyzed by statistical package for the social sciences program (SPSS). Results: A total of 635 KKU students completed the questionnaire. Female students were more than male students, 334 (52.6%) for females and 301 (47.4%) for males, respectively. Ages ranged from 18 to 24 years with a mean 23 ± 2 years. There was a good awareness for some of the factors related to the DR which is noted in the results. Awareness of smoking and pregnancy rate is extremely low compared to the rest of the factors related to the DR. Conclusion: There was high awareness regarding DR and its risk factors among KKU students but low awareness regarding smoking and pregnancy relationship with DR. Improvement is required for smoking and pregnancy with the progression DR.
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Affiliation(s)
- Abdulrahman Alamri
- Department Ophthalmology College of Medicine, King Khalid University, Saudi Arabia
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30
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Selfie fundus imaging for diabetic retinopathy screening. Eye (Lond) 2021; 36:1988-1993. [PMID: 34642496 PMCID: PMC8505467 DOI: 10.1038/s41433-021-01804-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background Regular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on the interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impede widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance diabetic retinopathy screening. Methods The study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone-based photographs captured by patients themselves after a short video-assisted training session (SFI group), and smartphone-based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular oedema grading. Findings Mean age of the study participants was 52.4 years ± 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31–45 s). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular oedema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91). Conclusion Fundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact the success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.
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Abstract
PURPOSE OF REVIEW Diabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. Although screening and early treatment guidelines for DR have significantly reduced the disease burden, restrictions related to the COVID-19 pandemic have changed real-world practice patterns in the management of DR. This review summarizes evolving guidelines and outcomes of the treatment of DR in the setting of the pandemic. RECENT FINDINGS Intravitreal injections for DR have decreased significantly globally during the pandemic, ranging from approximately 30 to nearly 100% reduction, compared to corresponding timepoints in 2019. Most studies on functional outcomes show a decrease in visual acuity on delayed follow-up. Changing practice patterns in the management of DR has led to fewer intravitreal injections and overall reduction in visual acuity on follow-up. As COVID variants emerge, it will be necessary to continue evaluating practice guidelines.
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Affiliation(s)
- Ishrat Ahmed
- grid.21107.350000 0001 2171 9311Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe Street, Maumenee 726, Baltimore, MD 21287 USA
| | - T. Y. Alvin Liu
- grid.21107.350000 0001 2171 9311Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe Street, Maumenee 726, Baltimore, MD 21287 USA
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Ihn Sook J, Eun Joo L. Current Status and Associated Factors of Annual Eye Examination Among People with Type 2 Diabetes Mellitus: Using the 7th National Health and Nutrition Examination Survey. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:239-246. [PMID: 34314881 DOI: 10.1016/j.anr.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/04/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the level of annual eye examination (AEE) and identify the associated factors among people with diabetes mellitus (DM). METHODS A secondary data analysis was conducted using data from the Korean National Health and Nutrition Examination Survey (2016-2018). A total of 1,465 people with DM (726 men and 739 women) aged ≥ 40 years were included. The data were analyzed using a complex sample analysis considering a combined sampling weight of 3 years. RESULTS In total, 29.5% and 12.0% of men and 36.3% and 24.1% of women underwent AEE, and EE at the time of diagnosis of DM, respectively. The AEE rate in men was significantly higher in those who were high school graduates and above (OR = 1.98), current non-smokers (OR = 1.82), had ≥ 10-year duration of DM (OR = 1.75,), and insulin use (OR = 2.81), and those with a normal body mass index (OR = 1.68). For women, the AEE rate was significantly higher in those aged 40-64 years (OR = 1.76) and with ≥ 10-years duration of DM (OR = 1.91). CONCLUSION The AEE rate among people with DM is unsatisfactory and needs to be improved. Health education on the importance of AEE, and the application of a reminder or alarm system should be designed to promote AEE to the high-risk population showing lower levels of AEE, including those with a longer duration of DM.
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Affiliation(s)
| | - Lee Eun Joo
- Dong-Eui University, Busan, Republic of Korea
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Fung MM, Yap MK, Cheng KK. Community‐based diabetic retinopathy screening in Hong Kong: ocular findings. Clin Exp Optom 2021; 94:63-6. [DOI: 10.1111/j.1444-0938.2010.00552.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mavis My Fung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
E‐mail:
| | - Maurice Kh Yap
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
E‐mail:
| | - Karen Ky Cheng
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China
E‐mail:
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Abstract
INTRODUCTION Telemedicine in ophthalmology, and specifically in retinal diseases, has made significant advancements in recent years. The COVID-19 pandemic has launched telehealth into a new era by creating demand from patients and physicians alike, while breaking down previous insurance, reimbursement, access and educational barriers. METHODS This paper reviews mulitple studies demonstrating the use of telemedicine in managing various retinal conditions before and during the COVID-19 pandemic. CONCLUSION Moving forward, promising new devices and models of care ensure that tele-retinal care will continue to expand and become a vital part of how we screen, diagnose and monitor retinal diseases.
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Affiliation(s)
- Eva Raparia
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States
| | - Deeba Husain
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States
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Sharif A, Jendle J, Hellgren KJ. Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study. Diabetes Ther 2021; 12:223-234. [PMID: 33165837 PMCID: PMC7649703 DOI: 10.1007/s13300-020-00957-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Screening for diabetic retinopathy (DR) prevents blindness through the early detection of sight-threatening retinal microvascular lesions that respond to timely local treatment. However, the provision of easy and regular access to DR screening programs is currently being challenged by the increasing prevalence of diabetes. One proposed solution is to extend the screening interval for patients at low risk for progression of retinopathy. To date, most providers of screening programs have hesitated to implement a strategy of extended intervals due to the lack of data on whether adherence and safety are compromised when retinal examinations occur less frequently. In the study reported here, we investigated adherence to the screening program and progression of retinopathy in patients with type 2 diabetes participating in a DR screening program with extended intervals. METHODS This was a retrospective study that included 1000 patients with type 2 diabetes mellitus who attended a screening program for DR. The patients were consecutively placed into a low-risk patient cohort with no retinopathy or into an intermediate-risk patient cohort with mild retinopathy (each cohort n = 500). Screening intervals were 36 months for the low-risk cohort and 18 months for the intermediate-risk cohort. RESULTS The 1000 subjects enrolled in the study had a median age of 68 (interquartile range 12) years and 60.4% were men. At the follow-up screening visit, data on 102 subjects were not included in the analysis of adherence rate due to death, severe systemic illness, other concurrent eye disease or migration. Among the 898 remaining subjects, adherence to the screening program was 93.7% (413/443) in the 36-month group and 98.3% (449/455) in the 18-month group (p < 0.0001). Non-adherence decreased with increasing age (odds ratio 0.92, 95% confidence interval 0.888-0.954, p = 0.0005). At follow-up, 65 subjects showed progression of retinopathy; none had worse than moderate retinopathy. Risk factors for DR and treatment for hyperglycemia, hypertension and hyperlipidemia were compared among subjects in the low-risk cohort: non-adherent subjects did not differ from their adherent counterparts without progression of DR, but the former had a shorter duration of diabetes and higher diastolic blood pressure than adherent subjects with progression of DR (4.5 vs. 7.5 years, p = 0.007; and 80 vs. 75 mmHg, p = 0.02, respectively). CONCLUSION The results suggest that screening DR at extended intervals can be achieved with high adherence rates without compromising patient safety. However, younger subjects and those at higher risk of progression may require extra attention.
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Affiliation(s)
- Ali Sharif
- Department of Ophthalmology, Karlstad Hospital, Region Värmland, Karlstad, Sweden.
- Diabetes Endocrinology and Metabolism Research Center, Örebro University, Örebro, Sweden.
- Institute of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Johan Jendle
- Diabetes Endocrinology and Metabolism Research Center, Örebro University, Örebro, Sweden
- Institute of Medical Sciences, Örebro University, Örebro, Sweden
| | - Karl-Johan Hellgren
- Department of Ophthalmology, Karlstad Hospital, Region Värmland, Karlstad, Sweden
- Diabetes Endocrinology and Metabolism Research Center, Örebro University, Örebro, Sweden
- Institute of Medical Sciences, Örebro University, Örebro, Sweden
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Zamorano LS, Calero Magaña P, García Cisneros E, Martínez AV, Martín LF. Cocoa olein glycerolysis with lipase Candida antarctica in a solvent free system. GRASAS Y ACEITES 2020. [DOI: 10.3989/gya.0794191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper we present the valorization of cocoa olein obtained from the acid fat-splitting of soapstocks. The aim is to develop a solvent free process (enzymatically catalyzed) to maximize the production of a final product with high content of monoglycerides (MAG) and diglycerides (DAG). The effect of the enzyme dose, glycerol content, reaction times as well as the modification of the raw material and pressure were studied. The yield of the reaction increased up to 90-95% when using a vacuum of 2-3 mbar at 65 °C, enough to evaporate the water which is generated as a by-product, an enzyme dose of 1% and molar ratio oil:glycerol of 1:2. The highest yield in terms of MAG and DAG production was obtained by starting from a raw material which was rich in free acidity (FFA), rendering oil with 33.4 and 44.2% MAG and DAG, respectively. Short reaction times (6-8 h) were observed compared to previously reported results (24 h).
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Wilcox S, Okut H, Badgett R, Hassouneh S, Ablah E. Effectiveness of Flow Sheet Implementation on Diabetes Progression Screening at a Student-Run Free Clinic. Kans J Med 2020; 13:285-289. [PMID: 33312411 PMCID: PMC7725131 DOI: 10.17161/kjm.vol13.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Diabetes mellitus (DM) disproportionately affects people with low socioeconomic status (SES). Student-run free clinics (SRFC) aim to care for low SES populations and experience high clinician turnover. Flow sheets have been used to improve care for those with diabetes, yet no research has assessed the use of such a flow sheet in a SRFC. The aim of this project was to determine if use of a flow sheet improved care for people with DM in an SRFC. Methods Charts from all patients receiving care for DM at one SRFC in the year before (n = 53) and after (n = 56) implementation of the flow sheet were reviewed. Pre- and post-group comparisons and post subgroup comparisons were made for glycosylated-hemoglobin (HgbA1c), microalbumin, and foot and eye exams. Results During a one-year period, a larger proportion of patients who received care post flow sheet introduction received at least two HgbA1c tests (53%), a microalbumin test (46%), and a foot-exam (46%) compared to those receiving care before the flow sheet (28%, 2%, and 25%, respectively). There was no difference in proportions of patients undergoing eye exams. In post subgroup analysis, flow sheets were used for 50% of patients, and patients who received care with the flow sheet were more likely to receive at least two HgbA1c tests and a foot exam per year. Conclusion Flow sheets may improve the process of care for patients with diabetes in a SRFC, but the effect must be studied further. Regardless, a systematic integration of the flow sheet is being implemented in the SRFC evaluated in this study.
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Affiliation(s)
- Samuel Wilcox
- Northwest Washington Family Medicine Residency, Bremerton, WA
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Robert Badgett
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Stephanie Hassouneh
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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Youn HM, Lee DW, Park EC. Association between community outpatient clinic care accessibility and the uptake of diabetic retinopathy screening: A multi-level analysis. Prim Care Diabetes 2020; 14:616-621. [PMID: 32144076 DOI: 10.1016/j.pcd.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/26/2020] [Accepted: 02/25/2020] [Indexed: 01/19/2023]
Abstract
AIMS To investigate the uptake rate variance of fundus examination for diabetes-related complications among demographically and geographically diverse communities and examine determinants that influence this rate focusing on outpatient eye care clinic accessibility at community level. METHODS Data of 20,904 participants with diabetes from 228 communities in 2015 were collected from the nationwide Community Health Survey and Statistics Korea. Outpatient eye care clinic accessibility was measured by the number of eye clinics per 1000 population. Multilevel analysis was conducted to assess the fundus examination uptake rate across communities and examine the association of individual- and community-level determinants with this rate. RESULTS The uptake rate among patients with diabetes was 34.8% and varied across communities. At the individual level, determinants related to knowledge and awareness were significantly positively associated with fundus examination uptake. At the community level, increases in the number of eye clinics were associated with significant increases in fundus examination uptake (OR 1.21; 95% CI 1.03-1.43). CONCLUSIONS Based on the result that outpatient eye care clinic accessibility was significantly associated with the uptake rate across communities, improving accessibility may be an important factor and should be considered when developing interventions for promoting regular diabetic retinopathy screening. This will lead to earlier detection of complications and minimize diabetes-related visual impairment.
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Affiliation(s)
- Hin Moi Youn
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Doo Woong Lee
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Institute of Health Services Research, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Fenwick EK, Man REK, Gan ATL, Aravindhan A, Tey CS, Soon HJT, Ting DSW, Yeo SIY, Lee SY, Tan G, Wong TY, Lamoureux EL. Validation of a New Diabetic Retinopathy Knowledge and Attitudes Questionnaire in People with Diabetic Retinopathy and Diabetic Macular Edema. Transl Vis Sci Technol 2020; 9:32. [PMID: 33062395 PMCID: PMC7533728 DOI: 10.1167/tvst.9.10.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose A validated questionnaire assessing diabetic retinopathy (DR)- and diabetic macular edema (DME)-related knowledge (K) and attitudes (A) is lacking. We developed and validated the Diabetic Retinopathy Knowledge and Attitudes (DRKA) questionnaire and explored the association between K and A and the self-reported difficulty accessing DR-related information (hereafter referred to as Access). Methods In this mixed-methods study, eight focus groups with 36 people with DR or DME (mean age, 60.1 ± 8.0 years; 53% male) were conducted to develop content (phase 1). In phase 2, we conducted 10 cognitive interviews to refine item phrasing. In phase 3, we administered 28-item K and nine-item A pilot questionnaires to 200 purposively recruited DR/DME patients (mean age, 59.0 ± 10.6 years; 59% male). The psychometric properties of DRKA were assessed using Rasch and classical methods. The association between K and A and DR-related Access was assessed using univariable linear regression of mean K/A scores against Access. Results Following Rasch-guided amendments, the final 22-item K and nine-item A scales demonstrated adequate psychometric properties, although precision remained borderline. The scales displayed excellent discriminant validity, with K/A scores increasing as education level increased. Compared to those with low scores, those with high K/A scores were more likely to report better access to DR-related information, with K scores of 0.99 ± 0.86 for no difficulty; 0.79 ± 1.05 for a little difficulty; and 0.24 ± 0.85 for moderate or worse difficulty (P < 0.001). Conclusions The psychometrically robust 31-item DRKA questionnaire can measure DR- and DME-related knowledge and attitudes. Translational Relevance The DRKA questionnaire may be useful for interventions to improve DR-related knowledge and attitudes and, in turn, optimize health behaviors and health literacy.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Alfred T L Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Amudha Aravindhan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching Siong Tey
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - San I Y Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Dogra A, Kaur K, Ali J, Baboota S, Narang RS, Narang JK. Nanoformulations for Ocular Delivery of Drugs - A Patent Perspective. ACTA ACUST UNITED AC 2020; 13:255-272. [PMID: 31985387 DOI: 10.2174/1872211314666200127101149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 01/29/2023]
Abstract
Efficient delivery of ocular therapeutics with improved efficacy, enhanced bioavailability, and acceptable patient compliance presents unique challenges. This can be attributed to the presence of protective mechanisms, physicobiological barriers, and structural obstacles in the eye. Nanotherapeutic interventions have been explored extensively over the past few years to overcome these limitations. The present review focusses on the nanoformulations developed for the diagnosis and treatment of various ocular diseases besides providing an in-depth insight into the patents reported for the same.
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Affiliation(s)
- Anmol Dogra
- Department of Pharmaceutics, Khalsa College of Pharmacy, Amritsar, Punjab-143001, India
| | - Kuljeet Kaur
- Department of Pharmaceutics, Khalsa College of Pharmacy, Amritsar, Punjab-143001, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Ramandeep Singh Narang
- Department of Oral & Maxillofacial Pathology and Microbiology, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab-143001, India
| | - Jasjeet Kaur Narang
- Department of Pharmaceutics, Khalsa College of Pharmacy, Amritsar, Punjab-143001, India
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Abstract
The purpose is to provide a twelve-month database review of screening for diabetic retinopathy (DR). A total of 1428 diabetes mellitus (DM) patients screened in 2017 were analyzed in a retrospective study. Retinal photographs were reviewed by an ophthalmologist for the presence and stage of DR, as well as for additional nondiabetic findings. The following grading categories of DR were used: without DR, mild non-proliferative DR (NPDR), moderate NPDR, severe non-proliferative NPDR, proliferative DR (PDR), clinically significant macular edema (CSME) and ungradable finding. Severe NPDR, PDR and CSME were classified as vision-threatening DR. Out of 1428 DM patients, 27 were diagnosed with type 1 DM and 1401 with type 2 DM, 353 of them had newly diagnosed type 2 DM. Without DR category was recorded in 85.2% of all eyes screened, 2.8% were ungradable, and 12% showed varying stages of DR. Vision-threatening DR was found in 2.8% and additional nondiabetic findings in 5.2% of all screened eyes. In the group of newly diagnosed type 2 DM, 92.5% of screened eyes were without DR, 3.1% were ungradable and 4.3% showed varying stages of DR. In the group of newly diagnosed type 2 DM, vision-threatening DR was recorded in 0.1% and additional nondiabetic finding in 5.7% of the eyes screened. In conclusion, a small proportion of screened DM patients with detected DR had vision-threatening DR.
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Alluhaymid YM, Alotaibi FY, Alotaibi AB, Albasha AM, Alnaim AS, Sabi EM, Mujamammi AH. Awareness of diabetic retinopathy among Saudis with diabetes type 2 in Riyadh city. J Family Med Prim Care 2020; 9:4229-4233. [PMID: 33110837 PMCID: PMC7586587 DOI: 10.4103/jfmpc.jfmpc_731_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess awareness of diabetic retinopathy (DR) for Saudis with diabetes mellitus (DM) type 2 in Riyadh City. Methods: A cross-sectional study that used self-administered questionnaires conducted in primary healthcare centers in Riyadh City between October and December 2019. Results: There were 267 Saudi participants with diabetes mellitus type 2 visiting primary healthcare clinics. (52.4%) were aged 40 years or above at time of diagnosis with diabetes. (73%) had diabetes for at least 5 years. Most of the participants have a good blood glucose control and they do home measurements. In regard to DR, (64.4%) of participants had no subjective or objective indicators of retinopathy, and (70%) had visited ophthalmology clinics. Majority of the participants were advised about DR or referred to an ophthalmologist by their primary physician, with the percentages being (64.8%) and (59.6%), respectively. Regarding other risk factors of DR, (19.5%) had a family history of DR, (23.2%) of participant are smokers and (41.6%) were hypertensives. Majority of the participants were aware about all the aspects of DR, its consequences, and appropriate management except the laser therapy. In terms of area of living and education respondents, who lived in the center of Riyadh City and the secondary level or less educated participants had the lowest level of education. Conclusions: Awareness of DR is acceptable but should not lead this information to reduced awareness and educational programs. Outreach researchers' efforts should cover other directions instead awareness of DR.
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Affiliation(s)
- Yousef M Alluhaymid
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fawzan Y Alotaibi
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah M Albasha
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Essa M Sabi
- Department of Pathology, Clinical Biochemistry Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed H Mujamammi
- Department of Pathology, Clinical Biochemistry Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Peavey JJ, D'Amico SL, Kim BY, Higgins ST, Friedman DS, Brady CJ. Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population. Clin Ophthalmol 2020; 14:2397-2403. [PMID: 32904606 PMCID: PMC7457718 DOI: 10.2147/opth.s258270] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the impact of socioeconomic disadvantage and diabetic retinopathy severity on follow-up for vision care among people with diabetes mellitus (DM) residing in rural Vermont and northern New York State. Methods A retrospective chart review of people with DM who visited our academic eye clinic at least once between October 1, 2015, and March 31, 2016, was done. Of 1,466 unique patient visits, 500 were chosen for full chart review by simple random sampling. DM follow-up within 1 year was recommended for 331 adults. Data about prescribed and actual follow-up intervals were extracted. Regression models were used to identify factors associated with poor attendance at follow-up appointments. Results Sixty-eight [20.5%] patients had poor follow-up, defined as no ophthalmology visit within double the prescribed interval. Of these, 57 were not seen in follow-up by the end of study observation. Poor follow-up was greatest among socioeconomically disadvantaged patients, as defined by Medicaid enrollment (odds ratio [OR], 1.95; 95% CI, 1.07–3.56) in comparison to non-disadvantaged patients. Follow-up was better among those with moderate or worse diabetic retinopathy (OR, 0.38 95% CI, 0.20–0.70), and those with macular edema (OR, 0.19; 95% CI, 0.057–0.62). Conclusion Medicaid insurance and better diabetic retinopathy status were associated with worse follow-up among our predominantly rural population of patients. Patients who did not follow-up within double the recommended interval were unlikely to follow-up at all. Interventions are needed to target those at highest risk for poor follow-up.
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Affiliation(s)
- Jeremy J Peavey
- Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA
| | - Samantha L D'Amico
- Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA
| | - Brian Y Kim
- Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center for Behavior and Health, Larner College of Medicine, Burlington, VT, USA.,Departments of Psychiatry and Psychological Science, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - David S Friedman
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher J Brady
- Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA.,Vermont Center for Behavior and Health, Larner College of Medicine, Burlington, VT, USA
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Green M, Tien T, Ness S. Predictors of Lost to Follow-Up in Patients Being Treated for Proliferative Diabetic Retinopathy. Am J Ophthalmol 2020; 216:18-27. [PMID: 32243878 DOI: 10.1016/j.ajo.2020.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify risk factors for patients with proliferative diabetic retinopathy (PDR) who are lost to follow-up (LTFU) while undergoing intravitreal injections of anti-VEGF (IVIs) and/or panretinal photocoagulation (PRP) at an urban institution. DESIGN Retrospective cohort study. METHODS A chart review was performed in a total of 418 adult patients with PDR who received IVI and/or PRP between January 1, 2014, and June 1, 2018, at the authors' institution. Rates of LTFU, risk factors associated with LTFU, and vision outcomes were assessed. RESULTS Of a total of 418 patients, 256 patients (61%) were LTFU. Risk factors positively associated with LTFU on multivariate analysis included non-English as the primary language (odds ratio [OR], 1.83; P = .006); age 56-65 years old (OR, 1.86; P = .014); age older than 65 years (OR, 1.94; P = .027) compared to age 55 years or younger; living 20 miles or less from the institution (OR, 2.68; P = .009); having greater than 5 comorbidities (OR, 2.38; P = .034); seeing 20 or more distinct departments (OR, 4.66; P = .007); missing more than 10% of non-eye care appointments (OR, 1.61; P = .038); and receiving only PRP compared to only IVIs (OR, 1.93; P = .031). CONCLUSIONS A high percentage of patients treated for PDR at the authors' institution were LTFU over a 4-year time span. Identifying patients at high risk for being LTFU may help in choosing treatment modality and appropriate patient counseling.
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Liu J, Gibson E, Ramchal S, Shankar V, Piggott K, Sychev Y, Li AS, Rao PK, Margolis TP, Fondahn E, Bhaskaranand M, Solanki K, Rajagopal R. Diabetic Retinopathy Screening with Automated Retinal Image Analysis in a Primary Care Setting Improves Adherence to Ophthalmic Care. Ophthalmol Retina 2020; 5:71-77. [PMID: 32562885 DOI: 10.1016/j.oret.2020.06.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Retinal screening examinations can prevent vision loss resulting from diabetes but are costly and highly underused. We hypothesized that artificial intelligence-assisted nonmydriatic point-of-care screening administered during primary care visits would increase the adherence to recommendations for follow-up eye care in patients with diabetes. DESIGN Prospective cohort study. PARTICIPANTS Adults 18 years of age or older with a clinical diagnosis of diabetes being cared for in a metropolitan primary care practice for low-income patients. METHODS All participants underwent nonmydriatic fundus photography followed by automated retinal image analysis with human supervision. Patients with positive or inconclusive screening results were referred for comprehensive ophthalmic evaluation. Adherence to referral recommendations was recorded and compared with the historical adherence rate from the same clinic. MAIN OUTCOME MEASURE Rate of adherence to eye screening recommendations. RESULTS By automated screening, 8.3% of the 180 study participants had referable diabetic eye disease, 13.3% had vision-threatening disease, and 29.4% showed inconclusive results. The remaining 48.9% showed negative screening results, confirmed by human overread, and were not referred for follow-up ophthalmic evaluation. Overall, the automated platform showed a sensitivity of 100% (confidence interval, 92.3%-100%) in detecting an abnormal screening results, whereas its specificity was 65.7% (confidence interval, 57.0%-73.7%). Among patients referred for follow-up ophthalmic evaluation, the adherence rate was 55.4% at 1 year compared with the historical adherence rate of 18.7% (P < 0.0001, Fisher exact test). CONCLUSIONS Implementation of an automated diabetic retinopathy screening system in a primary care clinic serving a low-income metropolitan patient population improved adherence to follow-up eye care recommendations while reducing referrals for patients with low-risk features.
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Affiliation(s)
- James Liu
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Ella Gibson
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Shawn Ramchal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Vikram Shankar
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Kisha Piggott
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Yevgeniy Sychev
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Albert S Li
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Prabakar K Rao
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Todd P Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Emily Fondahn
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
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Avidor D, Loewenstein A, Waisbourd M, Nutman A. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:16. [PMID: 32280309 PMCID: PMC7137317 DOI: 10.1186/s12962-020-00211-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/26/2020] [Indexed: 12/27/2022] Open
Abstract
Background Diabetic retinopathy (DR) is a significant global public health and economic burden. DR accounts for approximately 15–17% of all cases of total blindness in the USA and Europe. Telemedicine is a new intervention for DR screening, however, there is not enough evidence to support its cost-effectiveness. The aim of this study is to review the most recent published literature on economic evaluations of telemedicine in DR screening and summarize the evidence on the cost-effectiveness of this technology. Methods A systematic search of PubMed, Embase and Google Scholar for relevant articles published between January 2010 and January 2020. Studies were included if they met the following criteria: (1) recruited subjects with either type 1, type 2 diabetes (2) evaluated telemedicine technology (3) patients underwent primary screening for DR (4) compared a telemedicine-based intervention with standard care (5) performed an economic evaluation or provided sufficient data for evaluating the cost-effectiveness of the technology used. Results Of 2238 articles screened, seven studies were included. Four of the studies were conducted in developed countries: The United States, Singapore and two studies in Canada. Three studies were conducted in developing countries: India, Brazil and South Africa. The patient populations in all studies were diabetic patients over the age of 18, previously not screened for DR. All seven studies used a telemedicine program which included capturing a retinal image and subsequently transmitting it to an ocular imaging center to assess the severity of DR. All studies compared telemedicine to a standard screening method for DR, including the option of no screening as standard of care. Although telemedicine requires initial and maintenance costs, it has the potential to provide significant cost savings by increasing patients’ working ability, increasing independent living ability, increasing quality of life and reducing travel costs. Conclusions Diabetic retinopathy telemedicine technology has the potential to provide significant cost savings, especially in low-income populations and rural patients with high transportation costs.
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Affiliation(s)
- Daniel Avidor
- 1Sackler Faculty of Medicine, Tel-Aviv University (TAU), Tel-Aviv, Israel
| | - Anat Loewenstein
- 1Sackler Faculty of Medicine, Tel-Aviv University (TAU), Tel-Aviv, Israel.,2Ophthalmology Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michael Waisbourd
- 3Glaucoma Research Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Amir Nutman
- 1Sackler Faculty of Medicine, Tel-Aviv University (TAU), Tel-Aviv, Israel.,4Tel-Aviv Sourasky Medical Center and National Center for Infection Control, Tel-Aviv, Israel
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Zhu X, Xu Y, Lu L, Zou H. Patients' perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities. BMJ Open Diabetes Res Care 2020; 8:8/1/e000970. [PMID: 32193199 PMCID: PMC7103829 DOI: 10.1136/bmjdrc-2019-000970] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To understand the referral completion and explore the associated barriers to the referral after telescreening for diabetic retinopathy (DR) among people with vision-threatening DR (VTDR). RESEARCH DESIGN AND METHODS All participants with VTDR after DR telescreening in the communities completed the self-reported questionnaires to assess referral completion and their perspectives on referral barriers. Sociodemographic characteristics and perceived barriers related to incomplete referrals were identified by conducting univariate analysis and multiple logistic regression model. The final model was then built to predict incomplete referral. RESULTS Of the 3362 participants, 46.1% had incomplete referral. Old age and lower education level showed significant association with incomplete referral. Almost all participants had at least one barrier during the referral process. Knowledge-related and attitude-related barriers, including 'Too old to want any more treatment', 'Difficulty in getting time to referral', 'No serious illness requiring treatment at present', 'My eyes are okay', 'Distrust the recommended hospital' and 'Have not been diagnosed or treated before', and logistics-related barrier 'Mobility or transportation difficulties' showed significant association with incomplete referral. CONCLUSIONS The issue of incomplete referral after DR telescreening is serious among individuals with VTDR, particularly in the elder and low education level population. The negativity of knowledge-related and attitude-related factors might be more prominent than logistic barriers in predicting incomplete referral. Therefore, new strategies to improve the compliance with referral assist in optimizing the referral accessibility, and the ongoing educational support to improve the awareness of disease and increase the effectiveness of physician-patient communication.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mamillapalli CK, Prentice JR, Garg AK, Hampsey SL, Bhandari R. Implementation and challenges unique to teleretinal diabetic retinal screening (TDRS) in a private practice setting in the United States. J Clin Transl Endocrinol 2020; 19:100214. [PMID: 31956513 PMCID: PMC6957819 DOI: 10.1016/j.jcte.2019.100214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Adherence rates to published guidelines for diabetic retinopathy (DR) screening is between 35 and 60%. We evaluate a teleretinal DR screening (TDRS) program in a private practice vertically integrated system to increase compliance with retinal screening. METHODS A retrospective pre-post intervention longitudinal study was conducted in a private endocrinology practice using TDRS as the primary intervention. Compliance rates for diabetic retinal screening were compared between December 31, 2016 and December 31, 2018. RESULTS A total population of 3479 patients were evaluated. Retinal screening compliance improved from 56.5% of patients (1964) pre-intervention to 59.3% of patients (2064) post intervention. The McNemar test was used for statistical analysis and found the change significant (p = 0.004). CONCLUSIONS TDRS as an adjunct tool in a private practice endocrinology office significantly improved screening rates and can increase access to recommended diabetic eye care. However, the improvement in screening rates was smaller than other types of practice settings. We explore some of the unique challenges to implementation of TDRS in private practice settings.
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Affiliation(s)
| | | | | | | | - Ramanath Bhandari
- Springfield Clinic, 1025 S 6th Street, Springfield, IL 62703, United States
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Gibson DM. Estimates of the Percentage of US Adults With Diabetes Who Could Be Screened for Diabetic Retinopathy in Primary Care Settings. JAMA Ophthalmol 2020; 137:440-444. [PMID: 30703202 DOI: 10.1001/jamaophthalmol.2018.6909] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prior studies found that screening for diabetic retinopathy (DR) in primary care settings using telemedicine increased screening rates among individuals with diabetes. This finding has led to interest in expanding the use of primary care-based screening for DR. Objective To estimate the percentages of US adults with diabetes and high-risk US adults with diabetes who have regular contact with primary care physicians and therefore could potentially receive timely screening for DR in primary care settings. Design, Setting, and Participants The empirical analyses used data from the cross-sectional population-based 2016 National Health Interview Survey on US adults 18 years or older with self-reported diabetes (n = 3229). Based on previous research, individuals who had lower income, lower educational levels, or type 2 diabetes; who were African American or Hispanic, uninsured, or not using insulin or oral medication for diabetes; or who did not have DR were defined as being at high risk of missing recommended eye examinations. Data were collected throughout 2016 and analyzed from July 17 through November 5, 2018. Main Outcomes and Measures Outcomes were whether an individual visited a primary care physician and whether an individual missed having a dilated eye examination in the past year. Results The survey sample included 3229 participants. Using weighted percentages of the full sample, 15.3% (95% CI, 13.8%-17.0%) had lower income, 19.7% (95% CI, 17.8%-21.6%) had lower educational levels, 15.4% (95% CI, 13.5%-17.4%) were African American, 16.0% (95% CI, 13.7%-18.6%) were Hispanic, 6.1% (95% CI, 4.9%-7.5%) were uninsured, and 50.1% (95% CI, 47.7%-52.4%) were female; the mean age was 60.1 years (95% CI, 59.4-60.8 years). In addition, 87.7% (95% CI, 85.9%-89.3%) visited a primary care physician in the past year. Of those who did not receive a dilated eye examination in the past year, 82.2% (95% CI, 78.4%-85.4%) visited a primary care physician during the year. Except for the uninsured subgroup, more than 78% of each high-risk subgroup had visited a primary care physician in the past year. Conclusions and Relevance Screening for DR in primary care settings has the potential to provide timely screening to a large portion of US adults with diabetes because most US adults with diabetes, including those at high-risk of missing recommended eye examinations, have regular contact with primary care physicians.
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Affiliation(s)
- Diane M Gibson
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York
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Strul S, Zheng Y, Gangaputra S, Datye K, Chen Q, Maynard L, Pittel E, Russell W, Donahue S. Pediatric diabetic retinopathy telescreening. J AAPOS 2020; 24:10.e1-10.e5. [PMID: 31940500 DOI: 10.1016/j.jaapos.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the role of telemedicine screening for pediatric diabetic retinopathy (DR) and to identify risk factors for pediatric DR. METHODS The medical records of a telemedicine program at a tertiary, academic medical center over 17 months were reviewed retrospectively. Patients visiting an academic pediatric endocrinology clinic who met guidelines underwent telescreening. Presence of pediatric DR and risk factors for retinopathy were evaluated. RESULTS The fundus photographs of 852 patients 10-23 years of age were reviewed. Diabetic retinopathy was noted in 51 (6%). Patients with an abnormal screening photograph were compared to patients with diabetes who had normal screening photographs (n = 64). Older age, longer diabetes duration, type 1 diabetes, and higher average glycated hemoglobin (HbA1c) from the year prior to the photograph were associated with increased risk of retinopathy. Of these, longer duration (P = 0.003) and higher average A1c (P = 0.02) were significant after adjusting for sex, race, and age. CONCLUSIONS Our telemedicine program found a higher percentage of diabetic retinopathy screening non-mydriatic photographs than prior studies found through standard ophthalmic examinations. In this relatively small sample size, longer duration of disease and higher average A1c were associated with increased risk of having diabetic retinopathy in our study.
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Affiliation(s)
- Sasha Strul
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.
| | - Yuxi Zheng
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee; Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Sapna Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee
| | - Karishma Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University, Nashville, Tennessee
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura Maynard
- Vanderbilt Eskind Pediatric Diabetes Clinic, Nashville, Tennessee
| | - Eric Pittel
- Vanderbilt Eskind Pediatric Diabetes Clinic, Nashville, Tennessee
| | - William Russell
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University, Nashville, Tennessee
| | - Sean Donahue
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee
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