Transcript Journal Club Slides - JAMA Ophthalmology

JAMA Ophthalmology Journal Club Slides:
Diabetes Eye Screening in Minority Populations
Owsley C, McGwin G Jr, Lee DJ, et al; Innovative Network for Sight
(INSIGHT) Research Group. Diabetes eye screening in urban settings
serving minority populations: detection of diabetic retinopathy and other
ocular findings using telemedicine. JAMA Ophthalmol. Published online
November 13, 2014. doi:10.1001/jamaophthalmol.2014.4652.
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Introduction
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Use of a nonmydriatic retinal imaging camera plus evaluation of images
through telemedicine has been advanced as a strategy for diabetic
retinopathy (DR) screening.
– Particularly among patients with diabetes mellitus from ethnic/racial
minority populations with low utilization of eye care.
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Prior research indicates that DR screening programs are associated with:
– Lower rate of those with sight-threatening DR detected at subsequent
screenings.
– Lower incidence and prevalence of blindness in people with diabetes.
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Objective: To examine the rate and types of DR identified through a
telemedicine screening program using a nonmydriatic camera, as well as
the rate of other ocular findings.
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Methods
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Study Design: Cross-sectional study at 4 urban clinic or pharmacy
settings in the United States serving predominantly ethnic/racial minority
populations and uninsured persons with diabetes mellitus.
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Participants: Persons aged ≥18 years who had type 1 or 2 diabetes
mellitus presenting to the community-based settings.
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Data Analysis: Main outcomes were percentage of DR detection by type
and percentage of detection of other ocular findings. Analysis of variance
and χ2 tests were used to compare continuous and categorical data,
respectively, across groups.
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Limitations: Unknown whether those who participated were systematically
different from those who did not; information unavailable on percentage of
persons who declined participation.
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Results
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Total of 1894 persons participated in the screening program across sites,
with 21.7% having DR in at least 1 eye.
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The 3 sites that were clinics (Birmingham, Alabama; Miami, Florida;
Winston-Salem, North Carolina) had similar rates of DR (23.5%-24.3%),
whereas the site that was a pharmacy (Philadelphia, Pennsylvania) had a
lower rate (15.8%).
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Most common type of DR was background DR, which was present in 94.1%
of all participants with DR.
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Participants with DR had a longer duration of diabetes than did those without
DR (mean, 13.7 vs 8.8 years; P < .001).
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Almost half of the participants (44.2%) had ocular findings other than DR;
30.7% of other ocular findings were cataract.
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Results
Percentage of the sample with various levels of diabetic retinopathy in
either eye stratified by site and overall.
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Results
Number and Percentage of Patients With Other Ocular Findings
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Comment
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In a DR telemedicine screening program in urban clinic or pharmacy
settings in the United States serving predominantly ethnic/racial minority
populations, DR was identified on screening in approximately 1 in 5
persons with diabetes.
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The pharmacy setting had a lower DR rate than that of the clinics, an issue
for further study and clarification.
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The vast majority of DR was background DR, indicating high public health
potential for intervention in the earliest phases of DR when treatment can
prevent vision loss.
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That DR was more likely to be present in persons with longer durations of
diabetes underscores the importance for screening programs to target
individuals with long-standing diabetes.
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Comment
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Other ocular findings were detected at a high rate, in almost half of the
persons screened.
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These findings other than DR included cataract, glaucoma, and age-related
macular degeneration, all of which are sight-threatening and treatable
conditions.
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The detection of other ocular findings may be a potentially
underappreciated feature of DR screening programs for preventing vision
loss.
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Contact Information
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If you have questions, please contact the corresponding author:
– Cynthia Owsley, PhD, Department of Ophthalmology, School of Medicine,
University of Alabama at Birmingham, 700 S 18th St, Ste 609, Birmingham, AL
35294 ([email protected]).
Funding/Support
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This research was supported through Centers for Disease Control and Prevention
cooperative agreements with The Johns Hopkins University, University of Alabama at
Birmingham, University of Miami, and Wills Eye Hospital (5U58DP002651,
5U58DP002652, 5U58DP002653, 5U58DP002655). The grantees received additional
support directly from Alcon Research Institute (The Johns Hopkins University) and
from the EyeSight Foundation of Alabama, Research to Prevent Blindness, and the
Buck Trust (University of Alabama at Birmingham). Nidek provided the cameras and
operator training free of charge.
Conflict of Interest Disclosures
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Dr Friedman has consulted for Nidek Inc about devices unrelated to this project. No
other disclosures were reported.
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