Purpose: Diabetic retinopathy (DR) is a leading cause of blindness, yet a majority of adults with diabetes are noncompliant with annual ophthalmic screening recommendations. We hypothesized that point-of-care automated DR could increase the rate of compliance with recommended retinal surveillance in patients with diabetes when administered during primary care visits.
Methods: We performed a prospective cohort study of adults ages 18 or older with diabetes seen at a primary care clinic from 3/1/18 to 8/31/18. A retrospective chart review of adults with diabetes from the same clinic was also conducted and served as a historical control. Participants were screened using non-mydriatic fundus photography and automated DR screening software (Eyenuk Inc.). Those with positive or inconclusive screening results were referred to ophthalmology for comprehensive evaluation. Rates of compliance with referral recommendations were compared between the study participants and historical control.
Results: One hundred and sixty-five adults with diabetes were included in the prospective study cohort. Twelve (7.3%) screened positive for referable DR, 23 (13.9%) screened positive for vision threatening DR, and 47 (28.4%) had an inconclusive screening result. Those that screened negative (83 participants) were all confirmed not to have DR by independent review from a retina specialist. The rate of compliance with follow-up eye care in referred participants was 54.9% compared to a historical rate of 18.7% (p<0.0001, chi-squared).
Conclusions: The use of automated DR screening at our institution's primary care clinic reduced referrals for those with no retinopathy and increased the rate of compliance with follow-up eye care in those with positive or inconclusive screening results. These findings suggest that implementation of automated screening could effectively increase compliance with ophthalmic care among those with referable DR.
J.C. Liu: None. S. Ramchal: None. E. Gibson: None. K. Solanki: Employee; Self; Eyenuk Inc. Stock/Shareholder; Self; Eyenuk Inc. M. Bhaskaranand: Employee; Self; Eyenuk Inc. E. Fondahn: Consultant; Self; Greeley Company. R. Rajagopal: None.