Download Telemedicine and screening around the world

ARVO 2015 Annual Meeting Abstracts
220 Telemedicine and screening around the world
Monday, May 04, 2015 8:30 AM–10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 1420–1445/A0115–A0140
Organizing Section: Clinical/Epidemiologic Research
Contributing Section(s): Multidisciplinary Ophthalmic Imaging,
Retina
Program Number: 1420 Poster Board Number: A0115
Presentation Time: 8:30 AM–10:15 AM
Telemedicine for a broad population screening of retinal diseases
using non mydriatic fundus camera from optical centers: two
years results
Miguel A. Zapata2, 1, Gabriel Arcos1, Alex Fonollosa1, 3, Maximino
Abraldes4, 1. 1OPTretina, Barcelona, Spain; 2Ophthalmology, Hospital
Vall Hebron, Barcelona, Spain; 3Hospital de Cruces, Bilbao, Spain;
4
Ophthalmology, Complexo Hospitalario Universitario, Santiago de
Compostela, Spain.
Purpose: Describe the outcomes during the first two years of a very
specialize screening through a web platform using only a network of
retinologists for the images lectures.
Methods: We recommended the screening in all patients arriving to
the optician center. Opticians were responsible to collect the informed
consent and perform a fundus photograph using non-mydriatic
cameras. The ophthalmological report includes only diagnostic
impressions and recommendation of referral time to conventional
ophthalmological visit. Not definitive diagnosis was made; neither
treatment nor further tests were recommended. All acute symptomatic
patients, all findings exiting from strict normality and all patients with
retinal signs of high myopia were referred to the ophthalmologist.
Results: A total of 53.198 eyes from 26.627 patients were included,
ranged from 3 to 99 years old, with a mean age of 52,89 years. Mean
visual acuity was 0,91. There were a total of 1861 of known diabetics
(7%). From all patients 74,9% (19.952) were normal, 24,5% (6523)
were considered pathological and 0,57% (152) of cases were not
assessable. From a total of 6523 patients who were referred, were
urgently 7,28%, 11,74% did preferentially (within 2-3 weeks) and
-80,98% did in the ordinary way. Signs of age-related maculopathy
represented the most frequent pathology 1562 patients (5,9%).
Epiretinal membrane was the second most frequently detected
abnormality, with a total of 584 cases (2,2%). Choroidal nevi was the
third cause of abnormality with 460 patients. Suspicion of diabetic
retinopathy accounted for 347 patients, 5,3% of total pathological
cases.
An important increase of pathology was seen in patients over 50
years, 29.30 % of abnormalities in retinal photographs versus 11.2
% of abnormalities in the group under 50 years (p<0,0001; OR 3.41
IC 3.10-3.77). Patients with a myopic defect more than -3 spherical
equivalent had higher risk of present abnormalities in the retinal
images than the other patients (p=0.003; OR 1.15 IC 1.05-1.26).
Conclusions: Broad population screening is justified because of
the high rate of asymptomatic retinal abnormalities. There is a high
volume of patients going into the opticians and they should be
controlled by an ophthalmologist. The ophthalmic community should
lead these initiatives in order to preserve and guarantee the quality
standards.
Commercial Relationships: Miguel A. Zapata, OPTretina (E);
Gabriel Arcos, OPTretina (E); Alex Fonollosa, OPTretina (E);
Maximino Abraldes, OPTretina (E)
Program Number: 1421 Poster Board Number: A0116
Presentation Time: 8:30 AM–10:15 AM
Diabetic Retinopathy Teleretinal Screening: Computer Algorithm
versus Reading Center
Otis Bennett Walton1, Jacob Gross2, Alex Young1, Kathryn Camero1,
Yvonne I. Chu1, 3, Ricci Sanchez3. 1Ophthalmology, Baylor College
of Medicine, Houston, TX; 2Medical School, University of Texas at
Houston, Houston, TX; 3Harris Health System, Houston, TX.
Purpose: Use of diabetic teleretinal screening to assess for
sight threatening diabetic eye disease (STDED) is increasingly
common, but little research has been done to compare the screening
effectiveness of computer automated interpretation to manual
interpretation. We performed a retrospective chart review for diabetic
patients who received diabetic teleretinal imaging, and computer
algorithm results were compared with results from an image reading
center of ophthalmologists and optometrists.
Methods: In order to increase screening rates among asymptomatic
diabetics and direct patients with advanced disease to the eye
clinics, Harris Health System (Houston, TX) patients received
diabetic teleretinal screening in primary care clinics using nonmydriatic fundus photography. These images were analyzed by a
computer algorithm, which classified patients into a binary referral
or observation category. Each image was also reviewed by a trained
optometrist or ophthalmologist, and the level of diabetic retinopathy
was manually assigned. Results from 15,015 diabetic patients were
evaluated. Additionally, a supplemental, retrospective chart review
was performed for 384 patients determined by the reading center
to have STDED, defined by a diagnosis of either severe nonproliferative DR or proliferative DR, so that the clinical result could
be compared to both the computer based process and the reading
center. Sensitivity and false negative rates were calculated.
Results: Based upon the reading center diagnosis, the sensitivity
of the algorithm in detecting STDED was 66.4% (95% confidence
interval [CI] 62.8% - 69.9%), with a false negative rate of 2%. When
compared to the clinical fundus exam cohort with STDED, the
algorithm demonstrated 75% sensitivity (CI, 66.8% - 81.8%), with a
false negative rate of 1%. The positive predictive value of the manual
reading center in detecting clinically evident STDED was 62% (CI
55.4% - 68.4%).
Conclusions: In light of its low false negative rate, computer
algorithm-based diabetic teleretinal screening may be an effective
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
alternative to manual image interpretation in screening for one of the
leading causes of preventable blindness.
Commercial Relationships: Otis Bennett Walton, None; Jacob
Gross, None; Alex Young, None; Kathryn Camero, None; Yvonne
I. Chu, None; Ricci Sanchez, None
Program Number: 1422 Poster Board Number: A0117
Presentation Time: 8:30 AM–10:15 AM
Comparison Among Methods of Retinopathy Assessment
(CAMRA) study: Mydriatic, Non-Mydriatic, and Smartphone
Fundus Photography
Martha Ryan1, R Rajalakshmi2, Prathiba Venkat2, RM Anjana2,
Ranjani Harish2, KM V. Narayan1, Timothy W. Olsen1, VM Mohan2,
Andrew Hendrick1. 1Emory University, Atlanta, GA; 2Dr. Mohan’s
Diabetes Specialities Centre, Chennai, India.
Purpose: Fundus photography is a convenient though expensive tool
for the assessment of diabetic retinopathy (DR)1-3. A new alternative
is to use a smartphone camera4,5. The purpose of this study was to
compare the effectiveness of 3 fundus photography modalities to
detect DR.
Methods: Three hundred diabetic patients (600 eyes) were recruited
at a tertiary care center in Chennai, India. 3-field nonmydriatic
(NM) photography was performed using the Nidek [NIDEK Co.,
Hiroishi, Japan] Model AFC-230. Next, the patient’s eyes were
dilated and photographs were taken using the iPhone 5 (Apple, Inc.,
Cupertino, CA), Filmic Pro software [Cinegenix LLC, Seattle, WA]
and a 20D condensing lens using previously reported techniques4.
Then 7-field photography was taken with the Zeiss FF450 Plus
[Carl Zeiss Meditec, Inc. Dublin, CA]. Photos were reviewed in a
masked fashion by two retina specialists for presence and severity of
DR. Presence of macular edema or a grade worse than severe nonproliferative DR was considered sight threatening (STDR).
Results: Of 600 eyes, 11 (1.8%), 9 (1.5%) and 0 of the images were
not graded due to poor quality for the SP, NM, and mydriatic cameras
respectively. The sensitivity and specificity of NM detection of any
DR compared to the mydriatic photos was 0.81 (95% CI 0.75-0.86)
and 0.94 (95% CI 0.92-0.96), respectively. The sensitivity and
specificity of SP detection of any DR was 0.50 (95% CI 0.43-0.56)
and 0.94 (95% CI 0.92-0.97). The sensitivity and specificity of NM
detection of STDR was 0.54 (95% CI 0.40-0.67) and 0.99 (95%
CI 0.98-1.00), respectively. The sensitivity and specificity of SP
detection of sight threatening DR was 0.59 (95% CI 0.46-0.72) and
1.00 (95% CI 0.99-1.00). Representative images are shown in Figure
1.
Conclusions: SP photography offers advantages such as connectivity,
portability and low cost. The SP was less sensitive for detection of
DR compared with NM imaging. However, they performed similarly
for detection of STDR. We determine that this technique of SP
photography is inferior to NM fundus photos for screening of DR
in this population. As SP technology and advanced optics improve,
we feel that future technologies have potential to become reasonable
alternatives to traditional fundus cameras in telemedical screening.
Representative photos from each modality. Top and bottom series
show no retinopathy and macular edema respectively
Commercial Relationships: Martha Ryan, None; R Rajalakshmi,
None; Prathiba Venkat, None; RM Anjana, None; Ranjani
Harish, None; KM V. Narayan, None; Timothy W. Olsen, None;
VM Mohan, None; Andrew Hendrick, None
Support: This project was supported by an unrestricted departmental
grand from Research to Prevent Blindness and supported by NIH
Research Training Grant # R25 TW009337 funded by the Fogarty
International Center and the National Institute of Mental Health.
Program Number: 1423 Poster Board Number: A0118
Presentation Time: 8:30 AM–10:15 AM
Comparison of diabetic retinopathy screening results detected on
a mobile device versus desktop computer
Tyson Ward, Kerry Cotter, Zeina A. Haddad, Paul A. Yates.
Ophthalmology, University of Virginia, Charlottesville, VA.
Purpose: To compare tele-ophthalmic screening for diabetic
retinopathy (DR) results determined on a mobile device to results
determined with a traditional desktop computer. We sought to
evaluate the reliability of detecting DR on screening images using
mobile devices, as they are potentially a more efficient method of
communicating tele-ophthalmic screening results.
Methods: Over 8 months, 457 adult patients with diabetes underwent
tele-ophthalmic screening for DR at 3 primary care clinics in
Virginia. Trained clinical staff captured a single 45° macula-centered
image of each eye for each patient. Images were transmitted from
each clinic to ophthalmologists at the University of Virginia (UVA)
using TigerText, a secure, HIPPA-compliant messaging application.
The images were read by a UVA ophthalmologist on Samsung
Galaxy Note 2 and 3 mobile phones, and a preliminary interpretation
was given instantaneously. Up to one week after, images were
read again on a desktop computer with 24-inch LCD and a final
interpretation was given. Images were graded for image quality and
the presence and severity of DR (mild, moderate, or severe NPDR;
PDR). Agreement between image results was measured using percent
exact agreement and Cohen’s kappa coefficient (k).
Results: 435 of the total 457 patients (95%) were able to have
both eyes imaged; 870 eyes were assessed in this study. Exact
agreement between image quality assessment of preliminary and final
interpretations was observed in 745 (86%) eyes (Table 1), giving a k
of 0.76 ± 0.02. When comparing severity of DR on a mobile device
vs. a desktop computer, exact agreement was observed in 824 (95%)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
eyes (Table 2) with a k of 0.89 ± 0.02. Both k values are considered
excellent agreement.
Conclusions: Excellent agreement of both image quality
interpretation and DR severity grades was observed between
screening photos interpreted on a mobile phone and on a desktop
computer. These results demonstrate that mobile phones can be
used as an effective way to detect DR on screening images and
communicate results. This allows ophthalmologists to read screening
photos virtually anywhere at any time and to provide instantaneous
preliminary results to patients who participate in screening programs.
Comparison of DR severity grading on mobile device vs. desktop
computer
Comparison of image quality grading on mobile device vs. desktop
computer
Commercial Relationships: Tyson Ward, None; Kerry Cotter,
None; Zeina A. Haddad, None; Paul A. Yates, Genentech / Roche
(C), RetiVue, LLC (E), RetiVue, LLC (I), University of Virginia (P)
Program Number: 1424 Poster Board Number: A0119
Presentation Time: 8:30 AM–10:15 AM
Identification of Diabetic Retinopathy (DR) and Reduction in
Ungradable Image Rate with Ultrawide Field Imaging (UWFI)
within the Indian Health Service (IHS) Teleophthalmology
Program
Mark B. Horton1, Paolo S. Silva2, 3, Drew Lewis4, Jerry D.
Cavallerano2, 3, Lloyd Paul Aiello2, 3. 1Indian Health Service – Joslin
Vision Network National Reading Center, Phoenix, AZ; 2Beetham
Eye Institute, Joslin Diabetes Center, Boston, MA; 3Ophthalmology,
Harvard Medical School, Boston, MA; 4Estenda Solutions,
Conshohocken, PA.
Purpose: To evaluate the first implementation of UWFI within the
IHS DR ocular telehealth program in terms of DR identification and
ungradable rates compared to previously used nonmydriatic multifield fundus photography (NMFP).
Methods: Review of the IHS-Joslin Vision Network (JVN) program
deployed in 72 sites across the 26 states serving American Indian
and Alaska Native communities from May 27 to Nov. 25, 2014.
Patients underwent JVN imaging either with NMFP (NWS6S,
Topcon; stereoscopic pairs of 3-45 degree, 2-30 degree retinal fields,
and 1 external image) or UWFI (Daytona, Optos, plc; 200 degree
stereoscopic pair). Images were evaluated by JVN validated protocol
on identical color calibrated LCD high resolution monitors by
certified graders.
Results: A total of 7,460 subjects were imaged by NMFP and 456
were imaged by UWFI. Small statistically significant differences
existed between groups in age (mean NMFP 54 vs 51, p<0.001)
and gender (%female NMFP 57% vs 64%, p=0.004). No difference
existed in baseline diabetes duration. The eye ungradable rate for
DR and DME was lower with UWFI compared to NMFP (DR: 5%
vs 31%, p<0.001; DME: 6% vs 30%, p<0.001). DR identification
and referable DR (>moderate nonproliferative DR or DME) was
increased with UWFI from 12% to 23% (p<0.001) and from 6% to
14% (p<0.001), respectively. In eyes with DR imaged with UWFI
(N=206 eyes of 120 subjects), the distribution of peripheral retinal
lesions outside ETDRS fields was evaluated. H/Ma, venous beading,
IRMA and NVE were present in the periphery in 67%, 6%, 1% and
1%, respectively. Peripheral lesions suggested a more severe DR
diagnosis in 20% of eyes.
Conclusions: In a standardized DR ocular telehealth program serving
Native Americans across 26 states, nonmydriatic UWFI reduced
ungradable image rate by 85% to less than 5%. In addition, there
was a nearly 2-fold increase in DR identification and identification
of peripheral lesions suggested a worse DR severity in 20%.These
data suggest that UWFI may significantly improve DR identification
and acquisition of gradable images in a geographically diverse
population-based teleophthalmology DR programs.
Commercial Relationships: Mark B. Horton, None; Paolo S.
Silva, None; Drew Lewis, None; Jerry D. Cavallerano, None;
Lloyd Paul Aiello, Optos (R)
Program Number: 1425 Poster Board Number: A0120
Presentation Time: 8:30 AM–10:15 AM
Ultrawide Field Imaging (UWFI) for Diabetic Retinopathy in a
Community-Based Teleophthalmology Program
Nour Maya N. Haddad1, Ramon Cancino3, 4, Paolo S. Silva1,
2
, Eyiuche Okeke3, Ann Tolson1, Lloyd Paul Aiello1, 2, Jerry D.
Cavallerano1, 2. 1Retina, Joslin Diabetes Ctr/Beetham Eye Inst,
Boston, MA; 2Ophthalmology, Harvard Medical School, Boston,
MA; 3Mattapan Community Health Center (MCHC), Mattapan, MA;
4
Boston University School of Medicine/Boston Medical Center,
Boston, MA.
Purpose: To assess the outcomes of an ocular UWFI
teleophthalmology program in an urban community health center and
to determine the impact of peripheral retinal lesions on DR severity
in such a setting
Methods: We reviewed the outcomes of a Joslin Vision Network
(JVN) program from May 30, 2014 to November 10, 2014 deployed
at the Mattapan Community Health Center in Boston, MA which
serves a largely underserved population without ready access to
ophthalmic care. All patients underwent UWFI using a Daytona
Retinal Imager (Optos, plc, Dunfermine, Scotland, UK) following a
previously validated image acquisition protocol of 2000 stereoscopic
pairs of retinal images for each eye. All JVN images were evaluated
following a standardized validated protocol on identical color
calibrated LCD high resolution computer monitors by trained
licensed graders
Results: A total of 105 consecutive patients were imaged with UWFI.
Mean age was 63.1 years (±14.7), mean diabetes duration 9.4 years
(±8.4), 69.5% Female, and 90% black. DR severity by patient was
no DR 61.9% (65), very mild nonproliferative DR (NPDR) 10.5%
(11), mild NPDR 5.7% (6), moderate NPDR 6.7%(7), proliferative
DR (PDR) 5.7%(6), and ungradable 9.5% (10). Diabetic macular
edema (DME) was present in 7.6% (8) of the patients. Referable
DR (moderate NPDR or worse, or any level of DME) was present
in 16.2% of the patients. Peripheral DR lesions were present in
37.7% of eyes with DR, suggesting a more severe level of DR in
11.6%. Optic nerve evaluation was suspicious for glaucoma in 4.8%
of the eyes imaged. The monthly rate of ungradable patient images
decreased from 42.9% during the first two months to less than 5%
subsequently given increased imager experience over the 6 month
study period
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: The urban community-based implementation of a
teleophthalmology program in a largely underserved area identified
referable DR in over 16% of the population. Consistent with
published tertiary center cohorts, evaluation of the peripheral retina
using UWFI suggested more severe DR in 11% of eyes. Ungradable
image rates dropped dramatically with imager experience. These data
emphasizee the value of a DR teleophthalmology program in such
communities and the importance of ongoing quality assurance to
achieve and maintain low ungradable image rate
Commercial Relationships: Nour Maya N. Haddad, None;
Ramon Cancino, None; Paolo S. Silva, None; Eyiuche Okeke,
None; Ann Tolson, None; Lloyd Paul Aiello, OPTOS (R); Jerry D.
Cavallerano, None
Support: Optos plc provide a temporary loan of the Daytona imaging
device to the Mattapan Community Health Center. This study was
supported in part by grant funding from Boston Scientific
Program Number: 1426 Poster Board Number: A0121
Presentation Time: 8:30 AM–10:15 AM
Screening for Diabetic Retinopathy Using the Hand-Held
PICTOR Camera
Wenlan Zhang, Peter Nicholas, Stefanie Schuman, Michael
Allingham, Ambar Faridi, Suthar Tushar, Scott W. Cousins, Sasapin
G. Prakalapakorn. Ophthalmology, Duke University, Durham, NC.
Purpose: Diabetic retinopathy (DR) is a leading cause of low
vision and blindness; current DR classification was set by the Early
Treatment Diabetic Retinopathy Study (ETDRS) using 7 stereoscopic
retinal photographic fields taken by large tabletop cameras. While
studies have investigated DR screening protocols using < 7 fields
of view using tabletop cameras, none have investigated the ability
of a handheld fundus camera to screen for DR. The purpose of this
prospective study was to evaluate the feasibility of using a new FDAapproved, handheld, non-contact digital retinal camera, Pictor (Volk
Optical Inc., Mentor, OH), to obtain and evaluate retinal images for
the presence of DR compared to clinical exam findings.
Methods: Single fundus images of 56 adult diabetics (n=111 eyes)
were acquired by a single trained imager pre- and post-dilation with
the Pictor. Grading was performed by 5 masked ophthalmologists (1
general provider, 3 medical retina fellows, 1 medical retina attending)
using a modified ETDRS grading system. Grading accuracy was
compared to the dilated clinical examination findings obtained the
same day of imaging. Of the images felt to be interpretable, the
sensitivity and specificity of identifying low-risk (defined as no, mild,
and moderate non-proliferative diabetic retinopathy (NPDR) and
high-risk eyes (defined as severe NPDR and proliferative DR) for
each grader was calculated compared to the clinical exam findings.
Results: Graders felt images were interpretable in 86-94% of predilation photos and in 94-97% of post-dilation photos. Among the
post-dilation photos, the sensitivity for identifying low- vs highrisk eyes ranged from 50-56% and specificity ranged from 92-98%
compared to the clinical exam. Modifying the screening criteria by
grading for the presence of moderate NPDR, severe NPDR, or PDR,
the sensitivity for identifying high-risk eyes was 62-85% and the
specificity was 72-90%.
Conclusions: The Pictor camera can take high quality fundus images
that graders felt were of sufficient quality to screen for DR. While
graders evaluating single fundus images acquired by Pictor are
highly specific but not very sensitive in evaluating for high-risk DR,
a modified screening criterion increased the sensitivity of identifying
high-risk eyes with acceptable specificity. The Pictor camera may
be useful in screening for DR and other pathology localized to the
posterior pole.
Commercial Relationships: Wenlan Zhang, None; Peter Nicholas,
None; Stefanie Schuman, None; Michael Allingham, None; Ambar
Faridi, None; Suthar Tushar, None; Scott W. Cousins, None;
Sasapin G. Prakalapakorn, None
Program Number: 1427 Poster Board Number: A0122
Presentation Time: 8:30 AM–10:15 AM
Screening for diabetic retinopathy with a portable non-mydriatic
fundus camera
Sabyasachi Sengupta1, Paula Anne Newman-Casey2, Manavi
Sindal1, Cagri Besirli2, Swati Upadhyaya3, Rengaraj Venkatesh3,
Alan L. Robin2, 4. 1Vitreoretina, Aravind Eye Hospital, Pondicherry,
Pondicherry, India; 2Kellogg Eye Center, University of Michigan,
Ann Arbor, MI; 3Glaucoma services, Aravind Eye Hospital,
Pondicherry, Pondicherry, India; 4University of Maryland, Baltimore,
MD.
Purpose: The burden of diabetes and diabetic retinopathy (DR) is
increasing worldwide. Timely screening is an important strategy
to prevent needless blindness from DR. One reasonable approach
to high-quality DR screening is the use of a non-mydriatic fundus
camera However, most previously tested cameras are either tabletop
models limiting their portability and applicability in rural outreach
settings, or have poor resolution. The objective of this study is to
evaluate the sensitivity and specificity of a relatively inexpensive
handheld 45° non-mydriatic fundus camera (Smartscope, Optomed,
Finland) to aid in the remote diagnosis of vision-threatening diabetic
retinopathy (VTDR).
Methods: Subjects were recruited from a convenience sample of
diabetic and non-diabetic patients accessing the vitreoretinal service
at the Aravind Eye Hospital, Pondicherry, India. Three undilated
images (macula, nasal and superotemporal fields) were obtained from
each eye with the Smartscope. The subject then underwent complete
dilated fundus examination by a retina specialist as the gold standard
followed by dilated fundus imaging with the Smartscope and a
standard tabletop fundus camera (Topcon, Japan). All the images
were de-identified and graded remotely by two masked graders
(retina specialists) using the NHS guidelines for DR grading. VTDR
was defined as the presence of R2 level disease (≥ severe nonproliferative DR) and/or diabetic macular edema.
Results: We report preliminary results on 134 eyes of 81 subjects,
of whom 78% had diabetes for an average duration of 6 years and
37% had VTDR on clinical exam. Both graders reported ≥1 gradable
image in 88% of eyes using the undilated Smartscope and in 95%
eyes using either the dilated Smartscope or the Topcon. Graders 1 and
2 reported a sensitivity of 93% and 74% and a specificity of 82% and
97% respectively in identifying VTDR (k=0.66) with the undilated
Smartscope. Graders were relatively more concordant when reporting
VTDR interpreting the dilated Smartscope (sensitivity=92%, 85%
and specificity=81%, 96% respectively) (k=0.68) and Topcon images
(sensitivity=96%, 94% and specificity=91%, 94% respectively)
(k=0.89).
Conclusions: The Smartscope offers reasonable quality nonmydriatic images and it shows initial promise in meeting British
Diabetic Association standards of a sensitivity ≥80% to be considered
a useful portable tool for screening for VTDR in community outreach
programs.
Commercial Relationships: Sabyasachi Sengupta, None; Paula
Anne Newman-Casey, None; Manavi Sindal, None; Cagri Besirli,
None; Swati Upadhyaya, None; Rengaraj Venkatesh, None; Alan
L. Robin, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1428 Poster Board Number: A0123
Presentation Time: 8:30 AM–10:15 AM
Fully-automated Diabetic Retinopathy Screening Using
Cellphone-based Cameras
Sandeep Bhat1, Malavika Bhaskaranand1, Chaithanya
Ramachandra1, Todd P. Margolis2, Daniel A. Fletcher3, Kaushal
Solanki1. 1Eyenuk, Inc, Woodland Hills, CA; 2Ophthalmology and
Visual Sciences, Washington University School of Medicine, St.
Louis, MO; 3Bioengineering, University of California, Berkeley,
Berkeley, CA.
Purpose: Inexpensive retinal imaging and computerized screening
algorithms are critical for screening the large, growing diabetic
population for preventable vision loss due to diabetic retinopathy
(DR). To achieve this, we present an end-to-end point-of-care diabetic
retinopathy diagnostic device comprising an Ocular CellScope,
a cellphone-based retinal imaging camera and an image analysis
software enabling fully-automated screening for DR.
Methods: The Ocular CellScope is a retinal imaging device (shown
in Figure 1) that easily attaches to an iPhone without needing any
phone modification. The image analysis system utilizes novel
techniques customized for DR screening. The core steps include:
(i) image normalization, (ii) interest region detection, (iii) image
gradability assessment, (iv) multi-scale image description, and (v)
advanced machine learning techniques for multi-level classification.
DR lesions including microaneurysms, hemorrhages, exudates, cotton
wool spots, and neo-vascularization are detected and a Refer/No
Refer DR screening recommendation is generated.
We have obtained a dataset of 30 images (with 10 images having
known signs of DR) obtained from the first prototype of the Ocular
CellScope, which has since been improved. We evaluate our
automated DR screening software on this dataset by conducting a
cross-dataset test where the training is performed on a completely
independent dataset.
Results: On the cross-dataset test, our DR screening software
achieves AUROC of 0.94 (100% sensitivity at 80% specificity) for
identifying referable DR (moderate NPDR or higher on the ICDR
scale). Figure 2 shows examples of DR lesion detection using our
software on an Ocular Cellscope retinal image
Conclusions: The excellent performance of our DR screening
software on retinal images captured using the Ocular Cellscope,
demonstrates the robustness of our image analysis algorithms to
varying lighting conditions and image qualities. It also proves the
feasibility of retinal imaging using cellphone retinal cameras for DR
screening.
Cell phone based Ophthalmic device: (A) Ocular CellScope, an
iPhone based digital retinal camera. (B) Imaging of the patient retina.
(C) Generated retinal image sample.
Automatic Lesion detection on Ocular CellScope retinal images: (A)
original image. (B) detected hemorrhages. (C) detected exudates.
Commercial Relationships: Sandeep Bhat, Eyenuk, Inc. (E),
Eyenuk, Inc. (P); Malavika Bhaskaranand, Eyenuk, Inc. (E),
Eyenuk, Inc. (P); Chaithanya Ramachandra, Eyenuk, Inc. (E),
Eyenuk, Inc. (P); Todd P. Margolis, Washington University School
of Medicine (E); Daniel A. Fletcher, University of California,
Berkeley (E); Kaushal Solanki, Eyenuk, Inc. (E), Eyenuk, Inc. (P)
Support: NIH SBIR Grant 1R43EY024848-01
Program Number: 1429 Poster Board Number: A0124
Presentation Time: 8:30 AM–10:15 AM
EyeArt: Automated, High-throughput, Image Analysis for
Diabetic Retinopathy Screening
Kaushal Solanki1, Chaithanya Ramachandra1, Sandeep Bhat1,
Malavika Bhaskaranand1, Muneeswar G. Nittala2, Srinivas R.
Sadda2. 1Eyenuk, Inc., Woodland Hills, CA; 2Doheny Eye Institute,
Los Angeles, CA.
Purpose: Fully-automated screening solutions are indispensable to
screen the large, ever-increasing number of diabetics for preventable
blindness due to diabetic retinopathy (DR). EyeArt meets this need
with a computerized, highly accurate, cloud-based DR screening
system that enables screening of hundreds of thousands of images
in just a few hours. This enables seamless, large-scale screening
deployment to aid triage of DR patients in most need of eye-care.
Methods: EyeArt system utilizes novel image analysis techniques
customized for DR screening and is engineered for large scale
deployment on the cloud. The core steps include: (i) image
normalization, (ii) non-retinal (lens shot) image rejection, (iii) interest
region detection, (iv) multi-scale image description, and (v) advanced
machine learning techniques for multi-level classification. EyeArt
generates an aggregate DR screening recommendation by analyzing
multiple retinal images of a patient.
EyeArt was evaluated with the large, real-world public dataset
(Messidor 2) comprised of images from 874 patients (1748 eyes).
The gold standard image grading was obtained from Doheny Eye
Institute (DEI) where every image was carefully graded by an expert
on the ICDR severity level (0 for no DR and 4 for proliferative
DR) and Macular Edema (ME) level (0 for no ME and 1 for ME).
The expert used presence of exudates, retinal thickening, and/or
microaneurysms, all within 1 disc diameter of fovea, as sign of ME.
A patient was deemed non-referable if there was mild or no signs of
DR and no ME in both eyes.
Results: EyeArt produced Refer/No Refer screening recommendation
for each patient in Messidor2 dataset. EyeArt screening sensitivity
was 93.8% (95% CI: 91.0% - 96.6%), specificity of 72.2% (95% CI:
68.6% – 75.8%). This corresponds to 22 false negatives, all of which
were of moderate NPDR and did not meet the treatment criteria.
No ME cases were missed. The area under the receiver operating
characteristic curve (AUROC) was 0.941 (95% CI: 0.920 - 0.959).
Conclusions: The automated screening tool EyeArt has better
sensitivity than sensitivities of human graders reported on Messidor2
making it a safe and effective device for DR screening.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
ROC plot for EyeArt in identifying referrable diabetic retinopathy
(for the Messidor 2 dataset)
Commercial Relationships: Kaushal Solanki, Eyenuk, Inc (E),
Eyenuk, Inc. (P); Chaithanya Ramachandra, Eyenuk, Inc. (E),
Eyenuk, Inc. (P); Sandeep Bhat, Eyenuk, Inc. (E), Eyenuk, Inc.
(P); Malavika Bhaskaranand, Eyenuk, Inc. (E), Eyenuk, Inc.
(P); Muneeswar G. Nittala, Eyenuk, Inc. (F); Srinivas R. Sadda,
Eyenuk, Inc. (F)
Support: Research reported in this publication was supported by the
National Institute Of Biomedical Imaging And Bioengineering of the
National Institutes of Health under Award Number R44EB013585.
The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of
Health.
Program Number: 1430 Poster Board Number: A0125
Presentation Time: 8:30 AM–10:15 AM
Cloud-based Imaging Program for Diabetic Retinopathy
Screening and Monitoring
Pok Chien Tan1, Carol Y. Cheung1, 2, Ecosse Lamoureux1, 3, Wynne
Hsu4, Mong Li Lee4, Tien Yin Wong1, 2. 1Singapore Eye Research
Institute, Singapore, Singapore; 2Ophthalmology and Visual Sciences
Academic Clinical Programme, Duke-NUS Graduate Medical
School, National University of Singapore, Singapore, Singapore;
3
Centre for Eye Research Australia, University of Melbourne,
Melbourne, VIC, Australia; 4School of Computing, National
University of Singapore, Singapore, Singapore.
Purpose: We tested the performance of a cloud-based automated
imaging program for diabetic retinopathy (DR) screening and
monitoring as used in a Singapore screening program, with the aim
to reduce the workload of the trained graders for DR screening in
reading centre.
Methods: The Singapore Integrated Diabetic Retinopathy Screening
Programme (SiDRP) is a tele-medicine screening program for DR
based on assessment of retinal images of patients with diabetes seen
at the primary care setting. Currently, the assessment is based on
a standardized assessment of DR presence and severity by trained
non-ophthalmologists assessors (graders). To improve the efficiency
of the SiDRP screening, we developed and machine-trained a
prototype imaging software (SELENA), which is a cloud–based
tele-medicine platform that processes digital retinal images based on
pattern recognition and region extraction algorithms. The SELENA
system aims to classify diabetic patients into those that need and do
not need further assessment by trained graders. In addition, bringing
the program to a cloud platform can open it up to global use, without
geographical boundaries and limitations. The performance of the
SELENA system was tested and verified using an independent dataset
with varying severity of DR (200 diabetic patients) from the SiDRP.
Using the ophthalmologists’ clinical assessment as the reference
standard, the sensitivity, specificity, positive and negative predictive
values were calculated.
Results: Of the 200 patients, 84 had no DR, 66 had minimal/
mild DR, 50 had moderate or above DR. In the analysis by the
SELENA system, 4 patients were excluded as they were classified
as ungradable. 85 tested positive with DR, 96 falsely positive,
15 negative, and 0 falsely negative. The sensitivity and negative
predictive value of the SELENA software, were both of 100%.
However, the software shows low specificity of 13.5% and a positive
predictive value of 47%.
Conclusions: The SELENA system shows high sensitivity and
negative predictive values, which indicate that the software is
sensitive in identifying patients with a positive DR signal and ruling
out those with no DR, which serves its purpose as an effective
screening tool. Future work will focus on further refining the
SELENA software to improve its specificity prior to its large scale
use in the community, which will ultimately reduce the grading time
for DR screening.
Commercial Relationships: Pok Chien Tan, None; Carol Y.
Cheung, None; Ecosse Lamoureux, None; Wynne Hsu, None;
Mong Li Lee, None; Tien Yin Wong, None
Support: DUKE-NUS-TIDR/2010/0002
Program Number: 1431 Poster Board Number: A0126
Presentation Time: 8:30 AM–10:15 AM
Evaluation of an automated detection program for diabetic
retinopathy
Wei Xiao1, Canhong Wen3, Shan Zhu3, Mingguang He1, 2. 1Sun
Yat-sen University, Zhongshan Ophthalmic Center, Guangzhou,
China; 2Centre for Eye Research Australia, University of Melbourne,
Melbourne, VIC, Australia; 3Southern China Research Center of
Statistical Science, Sun Yat-sen University, Guangzhou, China.
Purpose: Automated detection program has the potential to reduce
the effort of image reading by raters. The purpose of this study is
to evaluate the performance of an automated detection program for
diabetic retinopathy (DR) and referable DR (RDR) from digital
retinal photographs.
Methods: Color retinal images of both DR and normal subjects
were collected from Zhongshan Ophthalmic Center. The 45-degree
photographs centered on the macular were chose for the present
analysis. Image gradability was assessed according to the DR
screening scheme of the United Kingdom National Screening
Committee. Retinal color photographs were graded independently for
retinopathy severity according to the International Clinical Diabetic
Retinopathy and Diabetic Macular Edema Disease Severity Scales by
two trained graders and adjudicated by a retinal specialist. Gradable
images were then analyzed by the automated assessment program.
Referable DR was defined as severer than mild non-proliferative DR
with or without macular edema.
Results: A total of 289 gradable images were assessed by the
automated program. The sensitivity and specificity for DR detection
was 91.6% (95%CI, 85.8% to 95.6%) and 59.6% (95%CI, 51.2% to
67.6%), respectively. In terms of RDR, the sensitivity of the program
raised to 93.5% (95%CI, 88.1% to 97.0%), and specificity was
60.0% (95%CI, 51.7% to 67.9%). The program was failed to detect
retinopathies in 9 of 139 DR cases (false-negative ratio: 3.10%). All
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
the nine images met the quality criteria for manual grading but were
relatively inadequate for autodetection.
Conclusions: Our automated detection program has high sensitivity
and specificity to detect DR and RDR. It can be served as an assistant
tool safely in DR screening projects, potentially reducing the
workload of graders on image reading.
The interface of the automated assessment program. (A) The original
image of the right eye from a patient with moderate NPDR and
macular edema. (B) A snapshot of the interface after automated
analysis. Retinal hemorrhages/microaneurysms and hard exudates
were marked with pink and yellow labels, respectively. Fundus
anatomic landmarks (e.g. optic disc, fovea) were detected and labeled
as well.
Commercial Relationships: Wei Xiao, None; Canhong Wen, None;
Shan Zhu, None; Mingguang He, None
Program Number: 1432 Poster Board Number: A0127
Presentation Time: 8:30 AM–10:15 AM
Initial Results of the Diabetic macular edema and diabetic
retinopathy Identification by screening (telemed) with Verified
automatEd Retinal photography (DIVER) Study
MICHAEL BENNETT. Retina Institute of Hawaii, Honolulu, USA
Minor Outlying Islands.
Purpose: Evaluate the process and results of 500 patients screened
for diabetic eye disease through collaboration between Retina
Institute of Hawaii and Primary Care practices utilizing a program
which included staff training, automated fundus photography and
telemedicine review techniques.
Methods: Retina Institute of Hawaii collaborated with 5 primary care
groups to develop a system to screen patients with diabetes for eye
disease. Primary Care practices were trained to use Nidek Automated
Fundus Photo Cameras on taking photos, uploading and transmitting
images. Images received were read by a Retina Specialist and a
report returned to the collaborating practice. Patients were counseled
on the results and the importance of annual visits to an eye doctor.
Patients were assessed at 6 months to see if a combination of photo/
counseling resulted in better documented diabetic care (A1C) and or
an annual visit to an eye doctor.
Results: After staff training, 500 patients with diabetes who had not
had a dilated eye exam in the past year were included in the study.
At baseline, 425/500 (85%) reported they had not seen an eye doctor
before. Grading of the photos by our Retina Specialists revealed
eye disease in 155/500 (31%) with 62/500 (12.4%) having diabetic
retinopathy (DR) of which 27% (17/62) of these also had diabetic
macular edema (DME). Other eye diseases detected (in 93/500
(18.6%) included hypertension, AMD, vitreous detachment, branch
retinal occlusion and presumed toxoplasmosis. After counseling,
a written report and photos at the 6 month assessment, 272/ 500
(54.4%) reported they had seen an eye doctor and the scheduled visit
occured quickly within 14-23 days on average. Patients and primary
care practices also showed improvement in their overall diabetes
control 319/ 500 (63.8%) having a HgA1C in the chart at baseline
that increased to 481/500 (96.2%) at the end of the study.
Conclusions: Initial results revealed a great need for intervention
with (85%) of diabetes patients having never seen an eye doctor
before. Some form of eye pathology appeared evident in roughly
one-third (31%) of 500 patients. Additionally, 12% had evidence
of diabetic retinal involvement. The program’s success seems to
include an increase in diabetic and associated educational awareness,
documented hemoglobin A1c and annual eye care visits.
Commercial Relationships: MICHAEL BENNETT, Retina
Institute of Hawaii (I)
Support: ML_28863
Program Number: 1433 Poster Board Number: A0128
Presentation Time: 8:30 AM–10:15 AM
Comparison of ultra-widefield Optos imaging with and without
phase mask implementation
Srinivas R. Sadda1, 2, Min Sagong1, 3, Jano van Hemert4. 1Doheny
Image Reading Center, Doheny Eye Institute, Los Angeles, CA;
2
Ophthalmology, University of California - Los Angeles, Los
Angeles, CA; 3Ophthalmology, Yeungnam University College of
Medicine, Daegu, Korea (the Republic of); 4Optos plc, Dunfermline,
United Kingdom.
Purpose: Due to the spherical curvature of the eye, conventional
ultra-widefield (UWF) images are sometimes affected by blurring
in the far periphery when the center of the image is in focus. To
compensate for this peripheral blurring, a phase mask has been
implemented in the Optos California device. In this study, we
compare far peripheral visualization utilizing the phase mask with
standard widefield imaging.
Methods: Twenty one patients (39 eyes) from a tertiary academic
retina practice with various diseases underwent UWF imaging
using the Optos California with phase mask implementation and the
Optos 200Tx without the phase mask. The images were obtained
as a single, non-steered image centered on the macula and then
transformed to stereographic projected images for assessment of far
peripheral (beyond the equator) visualization. Transformed images
were evaluated in a masked fashion by certified Doheny Image
Reading Center graders. Grading was performed separately for each
far peripheral quadrant (superior, inferior, nasal, temporal) for two
parameters: (1) visualization of the full extent of the vasculature
(terminus) and (2) sharpness of focus of the far peripheral vasculature
[graded as excellent (80% or more of vessels), adequate (80% - 50%),
or poor (50% or less)]. Results between the two devices were then
compared.
Results: The full extent of the far peripheral vasculature (to the
terminus) could be seen more frequently with the phase mask in
the superior (94.6% vs 5.4%, p<0.0001), nasal (91.9% vs 75.7%,
p<0.0001), and temporal (56.8% vs 43.2%, p=0.048) quadrants.
Inferiorly, there was no difference in the extent visualized due to lid/
lash artifact, however, the vasculature was in sharper focus with the
phase mask (excellent: 91.9% vs 83.8%, P = 0.019). The phase mask
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
also yielded a sharper focus in the superior (excellent: 94.6% vs
24.3%, p <0.001) and nasal (excellent: 89.2% vs 75.7%, P = 0.016)
quadrants.
Conclusions: The peripheral retina may be imaged effectively
by widefield imaging devices with or without phase mask
implementation. The phase mask, however, appears to improve
visualization of far periphery (particularly superiorly), allowing
the vasculature to be visualized to its full extent and in sharp focus.
These findings may be of value in designing imaging protocols for
assessment of the far periphery.
Commercial Relationships: Srinivas R. Sadda, Carl Zeiss Meditec
(C), Carl Zeiss Meditec (F), Carl Zeiss Meditec (R), Optos (C), Optos
(F), Optos (R); Min Sagong, None; Jano van Hemert, Optos plc (E)
Program Number: 1434 Poster Board Number: A0129
Presentation Time: 8:30 AM–10:15 AM
Retinopathy screening by flicker electroretinogram in diabetic
patients.
(subtitle: Diabetic retinopathy screening by ERG. )
Motonobu Fukuo1, Akira Hirose1, Shigehiko Kitano1, Mineo Kondo2.
1
Diabetes Ophthalmology, Tokyo Women’s Medical Unv, Shinjukuku, Japan; 2Ophthalmology, Mie Univ Graduate school of Medicine,
Tsu, Japan.
Purpose: Retinopathy screening is important in diabetic patients.
RETeval™ can easily evaluate the implicit time of flicker
electroretinogram (ERG) of eyes using not contact-lens but skin
electrodes, with no dark adaptation nor mydriasis, resulting to reduce
the burden and invasion on patients in examination compared to the
traditional ERG methods. We studied the capacity of RETeval in
screening on retinopathy of diabetic patients.
Methods: The Tokyo Women’s Medical University’s Ethics
Committee approved this study. A hundred and eighty eyes of
90 diabetic patients who visited our department for the first time
with written informed consent were included. Before mydriasis,
the implicit time of flicker ERG was recorded for each eye using
RETeval with white stimulus light, 8 Td-s stimulus intensity and 28.3
Hz frequency. Retinopathy was examined with ophthalmoscopy and
fudus photograph after mydriasis and was defined as positive (DR(+))
by the presence of any retinopathy, otherwise as negative (DR(-)).
The relation between retinopathy and implicit time was evaluated by
the Wilcoxon rank-sum test and the receiver-operator characteristic
(ROC) analysis. P<0.05 was considered significant.
Results: The mean age of 90 patients (57 males, 33 females) was
56.2 (SD ± 13.2, range: 23-83) years. Of the 180 eyes, 118 eyes were
DR(-) and 62 eyes were DR(+). Implicit time showed a significant
difference (P<0.001) between the DR(-) and the DR(+) eye groups
(mean±SD: 34.4±1.8ms and 37.4±2.5ms respectively). AUC (area
under the curve) in ROC curve analysis was 0.860. At cut-off values
of 35.0 and 34.5ms for implicit time, sensitivities were 87% and 97%,
specificities were 64% and 54% for DR(+) respectively.
Conclusions: RETeval seemed useful in screening retinopathy in
diabetics especially for its ability to rule out the DR(-) eyes in our
cohort.
Commercial Relationships: Motonobu Fukuo, None; Akira
Hirose, None; Shigehiko Kitano, None; Mineo Kondo, None
Program Number: 1435 Poster Board Number: A0130
Presentation Time: 8:30 AM–10:15 AM
Evaluation of the Impact of Retinopathy Screenings for Potential
Heart Transplant Candidates
Shira Simon, Alice T. Lyon, Lee M. Jampol. Ophthalmology,
Northwestern Hospital, Chicago, IL.
Purpose: Screening for retinopathy in heart transplant candidates
is broadly accepted as standard procedure in many hospitals’ and
insurance companies’ screening protocols and is a common reason for
ophthalmic consultation in hospitalized patients. However, no studies
exist to date evaluating the prevalence of retinopathy found in this
population, nor the value of these screenings in terms of influencing
whether a patient is eligible to receive a transplant. We performed a
retrospective chart review to determine the incidence of retinopathy
among heart transplant candidates at a tertiary medical center in order
to assess the effectiveness of this screening request.
Methods: We conducted a retrospective chart review of all heart
transplant candidates over the age of 21 from March 2008 to Oct
2014 at Northwestern Memorial Hospital. Ophthalmic examination
with indirect ophthalmoscopy was performed by both a resident
and a supervising attending on each inpatient consultation. The data
gathered included age and gender of the patient, whether an eye
evaluation was conducted, whether retinopathy was found, whether
the candidate received a heart transplant, the rationale if a patient was
rejected from heart transplant candidacy, and survival rate among the
transplanted population with retinopathy.
Results: There were 387 heart transplant evaluations undertaken
since 2008. 158 (41%) of these had consult requests for evaluation
of retinopathy. 66% of patients were male, and 33% were female.
Age ranged from 21 to 70, with a mean age of 54 years. Of the
158 evaluated, 16 (10%) were found to have retinopathy. Of these
retinopathy patients, 1 ( 0.63%) was excluded from transplant
eligibility on the basis of this finding.
Conclusions: Retinopathy is an infrequent finding in hospitalized
patients undergoing heart transplant evaluation. When found, it
seems to play a negligible and inconsistent role in whether the patient
receives a transplant. Reconsideration of this routine screening
criterion seems warranted in order to minimize unnecessary
procedures and to ensure more effective and efficient healthcare
delivery and systems.
Commercial Relationships: Shira Simon, None; Alice T. Lyon,
None; Lee M. Jampol, None
Program Number: 1436 Poster Board Number: A0131
Presentation Time: 8:30 AM–10:15 AM
Screening of Diabetic Retinopathy: Our experience using
telemedicine method in Mexican Population
Rafael A. Bueno-Garcia, Alvaro Rios-Poveda, J Guadarrama
-Cetina, Isrrael Navarrete, Ramses Ibarra. Retina, Oftalmocirugía
Especializada SA de CV, Mexico City, Mexico.
Purpose: This work is part of an community-based participatory
research project, to determinate the comparative effectiveness of
telemedicine with traditional survillance methods (annual foundus
eye exam in eye care provider’s office) for detect diabetic retinopathy
(DR)
This paper show The first stage of the project, that was developed
to provide preliminary information regarding the prevalence of eye
diseases in Mexico, and to measure the impact of non-mydriatic
cameras and telemedicine on preventing blindness from DR
Methods: Diabetic patients who underwent free DR screening with
a Topcon® TRC-NW8 non-mydriatic fundus camera were given
the recommendation to have an ophthalmic visit, in a time frame
suited to the DR stage or in case abnormalities in the macula, the
optic nerve. The photographs were performed by trained technicians
and the images was process through Synergy<span style=”font-size:11px”>TM<\>>
Ophthalmic Data Manegement System.
Results: A total of 1843 persons participated in the SYNERGY
plataform-screening program across sites, with 24.91% having DR
in at least 1 eye. The most common type of DR was non proliferative
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
DR, which was present in 48.55% of all participants with DR. Almost
one therd (33.97%) of the sample screened had ocular findings other
than DR; 30.7% of the other ocular findings were cataract.
Conclusions: In a DR telemedicine screening program in urban
hospital settings in Mexico serving predominantly low-income
populations, DR was identified on screening in approximately 2.5
in 10 persons with diabetes. The vast majority of DR was chronic,
indicating low public health potential for intervention in the earliest
phases of DR when treatment can prevent vision loss.
Commercial Relationships: Rafael A. Bueno-Garcia, Grupo Itsaya
(C), Novartis pharmaceuticals (F); Alvaro Rios-Poveda, Grupo
Itsaya (C); J Guadarrama -Cetina, None; Isrrael Navarrete, None;
Ramses Ibarra, None
Support: Novartis Pharmaceutical Support
Program Number: 1437 Poster Board Number: A0132
Presentation Time: 8:30 AM–10:15 AM
Improving health care delivery and quality assurance by
integration of a telemedicine diabetic retinopathy assessment
program with an electronic health record
Ingrid E. Zimmer-Galler1, Muge R. Kesen2, Richard Watson2. 1Wilmer
Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD;
2
Ophthalmology, West Virginia University, Morgantown, WV.
Purpose: Appropriate screening and timely treatment of visionthreatening diabetic eye disease has been demonstrated to
significantly impact vision outcomes in patients with diabetes.
Telemedicine technology has been shown to be an effective adjunct
method to increase adherence to guidelines for assessment of diabetic
retinopathy in patients with diabetes. With the advent of electronic
health records, an opportunity exists to dramatically enhance and
measure the performance of telemedicine systems to ensure delivery
of quality medical care. The purpose of this project is to describe the
novel integration of such systems and review the benefits in health
care delivery achieved with this innovative approach.
Methods: A telemedicine diabetic retinopathy assessment system
which features highly automated, non-mydriatic fundus cameras
and a cloud-based telemedicine platform with a remote reading
center was deployed in a university-based health care system. The
telemedicine platform was integrated into the electronic medical
record allowing seamless ordering, capturing of retinal images and
reporting of test results.
Results: Health care delivery benefits demonstrated with system
integration include optimizing program efficiency by simplifying
ordering of the screening test in the primary care setting, reducing
time to perform the point-of-care retinal imaging, facilitating referral
processes for screen-positive patients and streamlining billing and
capturing reimbursement for the imaging.
Enhancement of quality assurance measures achieved with
consolidation of telemedicine and electronic health record systems
include reporting the time between screening events and review of
results by the primary care physician, ensuring annual screening
intervals and confirming inclusion of reports in the permanent
medical record.
Conclusions: The integration of a diabetic retinopathy telemedicine
system with an electronic medical record holds significant promise
for advancing health care delivery, assessing quality measures and
meeting key performance indicators. Future directions with this
approach may include measuring discreet data points related to eye
disease, severity, treatment and time to treatment. Additionally,
integration with a patient database will allow a fail-safe method to
identify all eligible patients due for diabetic retinopathy assessment.
Commercial Relationships: Ingrid E. Zimmer-Galler, Intelligent
Retinal Imaging Systems (C); Muge R. Kesen, None; Richard
Watson, None
Program Number: 1438 Poster Board Number: A0133
Presentation Time: 8:30 AM–10:15 AM
Does non-mydriatic fundus photography based patient
health education improve adherence to diabetic eye follow up
examinations?
Van C. Lansingh1, Nathan G. Congdon2, Emilio E. Gonzalez Galarza3, 1. Pablo R. Cibils Farres3, 2. Pablo A. Pioli3, Ling Jin2,
Jason Penniecook4. 1Agency for the Prevention of Blindness/
VISION 2020, Queretaro, Mexico; 2Orbis International, New York,
NY; 3Retina, Fundacion Vision, Asuncion, Paraguay; 4Loma Linda
University, Loma Linda, CA.
Purpose: Patient adherence to long-term treatment is key to
reduction of visual impairment from diabetic retinopathy (DR). We
conducted a prospective, randomized intervention to evaluate if eye
fundus photography enhanced health talks (PEHT) would improve
patient adherence to follow-up examination instructions compared to
non-enhanced health talks (NEHT).
Methods: We enrolled all the 373 diabetic participants that visited
one of four different locations in Asuncion, Paraguay (?) from
November 2013 to June 2014.
After an initial examination and collection of demographic and
socioeconomic data, patients were given a standardized health talk
about the importance of treatment compliance and not missing
follow-up consultations. They were randomized to receive the NEHT
or PEHT. Participants were then asked to return for a follow-up
examination according to a previously established schedule based on
their diabetic retinopathy stage (graded by experienced personnel).
Results: After randomization, 193 participants (51.7%) were
assigned to PEHT and 180 (48.3%) to NEHT. The distribution of
DR classification was similar in both groups (p=0.26). 23 (11.9%)
participants in the PEHT and 19 (10.6%) participants in the NEHT
required a follow up examination within x weeks. In the PEHT group,
12 out of 23 participants (52.2%) returned as scheduled, while in
the NEHT, 10 out of 19 participants (52.63%) returned (p=0.95).
When analyzed by DR classification, only X participants classified
as having Grade 3 DR had increased adherence in the PEHT group
(NEHT x/y = z%, PEHT w/t = v%, p=0.014).
Conclusions: In patients with advanced DR, PEHT may increase
compliance to diabetic eye follow up examinations. Using
PEHT does not appear to increase patient adherence to follow up
instructions in those with early disease
Commercial Relationships: Van C. Lansingh, None; Nathan G.
Congdon, None; Emilio E. Gonzalez - Galarza, None; 1. Pablo R.
Cibils Farres, None; 2. Pablo A. Pioli, None; Ling Jin, None; Jason
Penniecook, None
Support: IAPB/ORBIS supported the pruchaisng of teh non
mydriatic camera used in the study
Program Number: 1439 Poster Board Number: A0134
Presentation Time: 8:30 AM–10:15 AM
The effect of immediate result feedback on compliance with
ophthalmic follow-up after diabetic retinopathy screening
Kerry Cotter, Zeina A. Haddad, Tyson Ward, Paul A. Yates.
Ophthalmology, University of Virginia, Charlottesville, VA.
Purpose: To assess the effect of immediate result delivery and
appointment scheduling on patient compliance with follow-up eye
care after diabetic retinopathy (DR) screening.
Methods: In 2011, a DR screening program was established at UMA,
a University of Virginia (UVA) primary care clinic. A nurse captured
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
45° macula-centered images of diabetic patients. Images were read
by a UVA ophthalmologist up to 1 week after screening. Patients
who needed follow-up at UVA Eye Clinic (due to presence of DR,
high A1C, ungradable photos or other pathology) were contacted
within 60 days. 1455 patients were imaged over 28 months. In 2014
TigerText, a secure HIPAA-compliant messaging application was
introduced. Using TigerText, UVA ophthalmologists read images on
mobile phones and sent interpretation results back to UMA within
5 minutes. If needed, the nurse scheduled an ophthalmic follow-up
at UVA immediately thereafter. 365 patients were imaged using this
method over 8 months.
Results: Of the 1820 patients imaged, 1154 (63%) patients were
recommended to schedule follow-up with an eye physician. The
follow-up completion rate was 71% before implementing instant
results and 57% after. The no-show rate was 15% before and 25%
after (Table 1), indicating that patient compliance surprisingly
decreased with faster result delivery. On average, the time elapsed
between a patient’s DR screening and follow-up was 116 days before
and 24 days after implementing instant results (Table 2), indicating
that less time passed between screening and follow-up after
introduction of TigerText.
Conclusions: Providing instant results and immediate scheduling
after screening does not necessarily improve the compliance rate
with follow-up eye care. The higher no-show rate observed after
introducing instant results can be partially attributed to the shorter
timeframe (8 vs. 28 months); a longer timeframe allows patients
to reschedule appointments. However, this study demonstrates that
immediate follow-up scheduling does decrease the time between
screening and subsequent ophthalmic referrals. Further data is needed
to evaluate this over a longer time period. This study shows that
implementing an online scheduling system that allows more efficient
scheduling and automatic reminders may be a worthwhile investment.
Table 1. Patient compliance with follow-up
Program Number: 1440 Poster Board Number: A0135
Presentation Time: 8:30 AM–10:15 AM
Patient and provider perspectives: Why are patients with
diabetes mellitus noncompliant with dilated eye exams?
Yamina Rajput1, Maxine Fisher2, Tao Gu2, Joseph Singer2, Amanda
Marshall2, Seonyoung Ryu1, John Barron2, Adam Turpcu1, Catherine
MacLean4, 3. 1Genentech Inc., San Francisco, CA; 2HealthCore, Inc.,
Wilmington, DE; 3David Geffen School of Medicine at UCLA,
Indianapolis, IN; 4Wellpoint, Indianapolis, IN.
Purpose: To estimate the proportion of commercially insured persons
with diabetes mellitus (DM) who do/do not receive annual dilated eye
exams and, using perspectives of the patient and the provider, identify
barriers to dilated eye exams and interventions that may improve
compliance.
Methods: Patients with DM were identified from the HealthCore
Integrated Research Database (HIRD). Patients who received ≥1
dilated eye exam between 8/1/11 and 7/31/13 were defined as
compliant, per Healthcare Effectiveness Data and Information Set
criteria.
DM patients identified from the HIRD who were complaint and
noncompliant with obtaining retinal exams, primary care physicians
and ophthalmologists, who met eligibility criteria with New York
City and Los Angeles zip codes, were invited to participate in 90-min
focus groups conducted by an experienced moderator. Proceedings
were recorded. Barriers and interventions cited were grouped into
common themes and rank ordered.
Results: Of the 339,646 DM patients identified via the HIRD, 43%
were compliant (mean age 59.2 y) and 57% were noncompliant
(mean age 54.5 y). A total of 29 patients (25 Type 2 DM, 18 male)
and 18 physicians (9 PCP, 9 ophthalmologists) participated in the
focus groups. Barriers to dilated eye exams are summarized in
Figures 1 and 2. Helpful interventions cited by patients included:
diabetic eye disease education, programs/sessions with diabetes
specialists (if free of charge, covered by insurance, and held at a
convenient time), motivational information on reminder postcards,
incentives (e.g. discounts on eye glasses), or a case manager to
coordinate, track, and inform patients about necessary tests and
appointments. Interventions cited by providers included: a national
spokesperson/celebrity who has dealt with diabetic retinopathy,
DVD/Web links providing video education of the exam and disease,
events/health fairs on diabetic retinopathy (similar to women’s health
programs), pamphlets with retinopathy pictures, web-based education
with links that can be publicized in-office, or alerts on electronic
records system for physicians to reinforce reminders.
Conclusions: Numerous perspectives were identified on patient
noncompliance with dilated eye exams, indicating the complexity of
this issue. Providers and payers may want to consider these issues as
they develop programs to improve rates of eye exams and outcomes
among DM patients.
Table 2. Time between screening and completed follow-up
Commercial Relationships: Kerry Cotter, None; Zeina A.
Haddad, None; Tyson Ward, RetiVue, LLC (I); Paul A. Yates,
Genentech / Roche (C), RetiVue, LLC (E), RetiVue, LLC (I),
University of Virginia (P)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Commercial Relationships: Yamina Rajput, Genentech Inc. (E);
Maxine Fisher, Genentech Inc (C), Healthcore Inc (E); Tao Gu,
Genentech Inc (C), Healthcore Inc (E); Joseph Singer, Genentech
Inc (C), Healthcore Inc (E); Amanda Marshall, Genentech Inc
(C), Healthcore Inc (E); Seonyoung Ryu, Genentech Inc. (E); John
Barron, Genentech Inc (C), Healthcore Inc (E); Adam Turpcu,
Genentech Inc. (E); Catherine MacLean, David Geffen School of
Medicine at UCLA (E), Genentech Inc (C)
Support: Genentech, Inc., South San Francisco, CA, provided
support for the study and participated in the study design; conducting
the study; and data collection, management, and interpretation.
Program Number: 1441 Poster Board Number: A0136
Presentation Time: 8:30 AM–10:15 AM
Prevalence of Diabetic Retinopathy in Screening-detected
Diabetes mellitus: Results from the Gutenberg Health Study
(GHS)
Norbert Pfeiffer1, Katharina A. Ponto1, 5, Philipp Raum1, Julia
Lamparter1, Tunde Peto2, Jochem König4, Philipp S. Wild3, 5, Alireza
Mirshahi1. 1Ophthalmology, University Medical Center Mainz,
Mainz, Germany; 2Moorfields Eye Hospital, London, United
Kingdom; 3Preventive Cardiology and Preventive Medicine, Dept.
of Medicine 2, University Medical Center Mainz, Mainz, Germany;
4
Institute for Medical Biostatistics, Epidemiology and Informatics,
University Medical Center Mainz, Mainz, Germany; 5Center for
Thrombosis and Hemostasis (CTH), University Medical Center
Mainz, Mainz, Germany.
Purpose: Type 2 diabetes mellitus (T2D) is characterised by a long
asymptomatic period of hyperglycaemia. Therefore, complications
such as diabetic retinopathy (DR) and diabetic maculopathy (DMac)
may be present even at the time of diagnosis. The GHS is the first
population-based study to collect data on the prevalence of DR and
DMac in newly diagnosed (detected in screening) T2D.
Methods: GHS is a population-based, prospective, observational
cohort study in midwestern Germany with a total of 15010
participants aged between 35 and 74. Participants underwent a
standardized protocol including an ophthalmic examination and a
complete general examination focused on cardiovascular parameters.
The analyses of the fundus photographs were carried out at
Moorfields Eye Hospital Reading Center by two certified graders
according to the recommendations of the Early Treatment Diabetic
Retinopathy Study. The sample was stratified by gender and decades
of age. Percentages are given after reweighting according to the
population structure of the recruitment area.
Results: Of 14,948 participants included into this analysis 1,377
had T2D (males 9.3% / females 6.2%). Of these, 25% (247/1377)
had newly diagnosed T2D (screening-detected, defined by HbA1C
≥ 6.5%). The total prevalence of newly diagnosed T2D was 2.0%
(males: 2.4% / females: 1.7%; < 65 years 1.6% / ≥ 65 years 3.7%).
The fundus photographs of at least one eye of 283 participants with
T2D were eligible for analysis. The overall prevalence of DR in
screening detected T2D was 12.9%, whereas it was 12.0%, 0.6%, and
0.3% for mild or moderate non-proliferative, and for proliferative
DR, respectively. No case of DMac was observed.
The prevalence of DR in subjects younger than 65 years was 13.5%
(13.0% for mild non-proliferative DR, 0% for moderate nonproliferative DR and 0.5% for proliferative DR), whereas it was
11.8% (10.1%, 1.7%, 0%) in those aged ≥ 65 years.
Conclusions: In this population-based study the prevalence of
screening-detected T2D was low but one of eight of these newly
diagnosed diabetics had evidence of diabetic retinopathy. In view of
the high rate of microvascular complications at time of diagnosis,
screening for diabetes is recommended. Community awareness and
physician coordination should be emphasized to increase the eye
examination rate in these individuals.
Commercial Relationships: Norbert Pfeiffer, None; Katharina A.
Ponto, None; Philipp Raum, None; Julia Lamparter, None; Tunde
Peto, None; Jochem König, None; Philipp S. Wild, None; Alireza
Mirshahi, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Support: The Gutenberg Health Study is funded through the
government of Rhineland-Palatinate (Stiftung Rheinland-Pfalz für
Innovation“, contract AZ 961-386261/733), the research programs
“Wissen schafft Zukunft” and “Center for Translational Vascular
Biology (CTVB)” of the Johannes Gutenberg-University of Mainz,
and its contract with Boehringer Ingelheim and PHILIPS Medical
Systems, including an unrestricted grant for the Gutenberg Health
Study. PSW is funded by the Federal Ministry of Education and
Research (BMBF 01EO1003).
Program Number: 1442 Poster Board Number: A0137
Presentation Time: 8:30 AM–10:15 AM
Prevalence of Common Eye Diseases in Diabetic Patients
Followed by Telemedicine
Dong-wouk Park1, Steven L. Mansberger2, 1. 1Casey Eye Institute,
Oregon Health and Science University, Portland, OR; 2Devers Eye
Institute, Portland, OR.
Purpose: Clinics may use telemedicine to screen for diabetic
retinopathy in diabetic patients. We were interested in the prevalence
of other eye diseases.
Methods: We recruited diabetic patients 18 or older who have
difficulty acquiring annual diabetic retinopathy screening
examinations from Yellowhawk Tribal Health Center (Pendleton,
OR) and Hunter Health Clinic (Wichita, KS). We randomly assigned
the edparticipants to either the telemedicine or traditional surveillance
group. We determined the prevalence of early age-related macular
degeneration (ARMD, defined as having soft drusen > 125 microns,
or drusen with pigmentary changes without late ARMD, not caused
by any other disorder) and late ARMD (defined as having macular
fluid, geographic atrophy, or neovascular maculopathy within the
macula, not caused by any other disorder), glaucomatous features
(defined as having rim thinning, nerve fiber defect, or excavation),
macular edema (defined as having retinal thickening within 500 lm of
the fovea, exudates associated with retina thickening within 500 lm
of the fovea, or retinal thickening of one disc diameter in size within
one disc diameter of the fovea), and other disease. We used both eyes
of a participant to determine ocular burden of disease, as we were
interested in the prevelance of the eye disease in either diabetic eye.
Results: We included 820 eyes from 460 patients for analysis. While
598/820 (72.9%) eyes had normal eye images, 195/820 (23.8%) eyes
had one disease identified, 20/820 (2.4%) had two diseases identified
simultaneously, and 7/820 (0.85%) eyes had three diseases identified
simultaneously. The most common ocular diseases included diabetic
retinopathy (143/820, 17.4%), glaucomatous features (56/820,
6.83%), dry ARMD (31/820, 3.8%), and macular edema (5/820,
0.61%). Other less frequent diseases included epiretinal membrane,
and choroidal/retinal lesion such as nevi.
Conclusions: Most diabetic patients do not have visually significant
eye disease requiring a subsequent visit with an ophthalmologist.
However, diabetic patients may have other eye diseases such as
glaucoma and macular degeneration, which require eye care provider
follow-up.
Commercial Relationships: Dong-wouk Park, None; Steven L.
Mansberger, Alcon Laboratories (C), Allergan (C), Allergan (F),
Envisia (C), Mobius (F), National Eye Institute (F), Santen, Inc. (C),
Vision5 (C)
Support: This research was supported by grant funding from the
National Eye Institute (NEI 3 K23 EY0155501-01), the Centers
for Disease Control and Prevention (CDC U48DP000024-01 and
1U48DP002673-01), and the Good Samaritan Foundation at Legacy
Health.
Clinical Trial: NCT01364129
Program Number: 1443 Poster Board Number: A0138
Presentation Time: 8:30 AM–10:15 AM
Community-based screening for blinding eye disease: the Kress
Vision Program
Alexander D. Port1, 2, June Vutrano3, Jia Lee1, Grace Wang1, Robison
V. Chan1, Grace Sun1. 1Ophthalmology, Weill Cornell Medical
College, New York, NY; 2Internal Medicine, NYU-Langone Medical
Center, New York, NY; 3Kress Vision Program, New York, NY.
Purpose: Vision loss due to common ocular disease such as cataract
and glaucoma is largely preventable with timely diagnosis and
treatment. However, at-risk individuals may lack access to vision
care. Community-based screening aims to address these issues
through direct outreach to at-risk populations. In this project, we seek
to evaluate a community-based ophthalmic screening program.
Hypothesis: Community-based screening will aid in the timely
identification of preventable cases of blindness or visual disability.
Methods: Kress Vision is a non-profit that provides free eye exams,
prescription glasses, and ophthalmologic referral care to community
groups. We reviewed screening data from Jan-Feb 2013. Exam
results (visual acuity, tonometry, visual fields and fundoscopic exam)
and demographic factors were recorded. For referrals, the reason
for referral was recorded, and medical records were reviewed to
determine a final diagnosis. Descriptive and correlational statistics
were performed.
Results: From Jan-Feb 2013, 197 adults were screened. 113 (57.4%)
were female and mean age was 43.4 (SD= 18.9). A majority of
screening clients were uninsured (n=116; 58.9%) and had not
received an eye exam in the past two years (n= 130; 66.0%).
Uninsured clients were more likely to report never having an exam in
the past (OR 4.17, 95% CI: 1.89, 9.20, p= 0.0001).
Refractive errors were common: 95 (48.2%) had initial VA worse
than 20/40, and 173 (87.8%) required new prescription glasses. 47
(23.9%) clients were referred for ophthalmologic care. Common
reasons for referral were: glaucoma suspect (22), need for dilated
exam (15), cataract (5), and pterygium (5). Ultimately, 28 clients
(59.6% of referrals) had vision-threatening disease, and 12 (25.5%)
received timely treatment for vision-threatening conditions, including
cataract extraction (3), pterygium excision (2), glaucoma treatment
(2), PRP for diabetic retinopathy (1) and others (4). Complete results
are depicted in figure 1.
Conclusions: Kress Vision is a community-based screening program
that is effective in the timely detection and management of visionthreatening conditions. Kress serves a largely uninsured population
with a high burden of disease. The majority of persons referred
from screening were found to have vision-threatening disease and a
significant portion required surgical management.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
cataract (6%), other (14%), and normal exam (12%). Of the 8/74
(11%) referred patients who did not attend their appointments,
reasons included patient cancelled appointment, work conflicts, or
forgetfulness. Patients travelled a mean of 16.6 miles (range 0-50
miles) to attend appointments. Mean time from patients’ last effort to
seek eye care was 7.1 years (range 1-54 years).
Conclusions: This study underscores the high prevalence of unmet
eye care needs in a rural population. Furthermore, we demonstrate
that using community health centers as a patient base for screening
can yield a high referral attendance rate for this at-risk population and
facilitate entrance into the eye care system in a rural setting.
Commercial Relationships: Edmund Tsui, None; Andrew N.
Siedlecki, None; Jie Deng, None; Margaret J. Chowaniec, None;
Sandolsam Cha, None; Susan M. Pepin, None; Erin M. Salcone,
None
Figure 1: Complete results of screening and referral. Visionthreatening disease in red.
Commercial Relationships: Alexander D. Port, None; June
Vutrano, None; Jia Lee, None; Grace Wang, None; Robison V.
Chan, None; Grace Sun, None
Support: Fight for Sight: Summer Student Fellowship (ADP),
Departmental Grant from Research to Prevent Blindness (ADP, JL,
GW, RVPC, GS), The St. Giles Foundation (RVPC)
Program Number: 1444 Poster Board Number: A0139
Presentation Time: 8:30 AM–10:15 AM
Implementation of a vision-screening program in rural
northeastern United States
Edmund Tsui1, 2, Andrew N. Siedlecki2, Jie Deng2, Margaret J.
Chowaniec2, Sandolsam Cha2, Susan M. Pepin3, Erin M. Salcone3.
1
Department of Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon, NH; 2Geisel School of Medicine at Dartmouth, Hanover,
NH; 3Section of Ophthalmology, Dartmouth-Hitchcock Medical
Center, Lebanon, NH.
Purpose: Rural populations face unique barriers in receiving health
care. Although the utility of vision screening has been evaluated in
urban settings, there have been limited investigations within rural
communities in the United States. We aim to evaluate the efficacy
of a medical student-run free vision-screening clinic as a strategy
to overcome barriers to accessing eye care in New Hampshire and
Vermont.
Methods: Medical students were trained by an ophthalmologist
to administer screening eye examinations. Patients (n=103)
from New Hampshire and Vermont were prospectively enrolled
through a free community clinic. Screening included a medical
history questionnaire, distance and near visual acuity, extraocular
movements, confrontational visual fields, and Amsler grid. Patients
who met predetermined screening criteria were referred to an
ophthalmologist or optometrist for further evaluation. Data including
patient demographics, appointment attendance, and diagnoses
were recorded and analyzed. Dartmouth College IRB approval was
obtained.
Results: Of 103 patients (45.5±12.3 years, 63% female), 74/103
(72%) were referred for further evaluation, and 66/74 (89%)
attended their referral appointments. Abnormal ophthalmological
exam findings were found in 58/66 (88%) of patients who attended
their referral appointment. Uncorrected refractive error was the
most common primary diagnosis in 38% of referred patients. Other
diagnoses included glaucoma suspect (21%), retinal disease (8%),
Program Number: 1445 Poster Board Number: A0140
Presentation Time: 8:30 AM–10:15 AM
School Vision Screening Program for Children in the School
District of Philadelphia: Year 1 Outcomes
Judie Tran1, Lisa A. Hark1, Harjeet Sembhi1, Melanie Snitzer1,
Vinit Awatramani1, Angela Rice2, Micheal Pond1, Shayla Stratford1,
Deiana M. Johnson1, Alex V. Levin1. 1Department of Research, Wills
Eye Hospital, Philadelphia, PA; 2Office of Specialized Services,
Philadelphia School Distinct, Philadelphia, PA.
Purpose: Annual vision screenings in children are critical to identify
and treat serious eye disorders. The purpose of this study was to
conduct vision screenings in elementary students in the School
District of Philadelphia (SDP) and to identify students who had
refractive error and ocular pathology. Students with a refractive error
were prescribed glasses and students with ocular pathology were
referred to a pediatric ophthalmologist at Wills Eye Hospital.
Methods: Vision screenings were conducted in 15 schools (grades
K-5) in the SDP in Spring 2014. Distance vision, near vision,
stereopsis, and color vision were assessed in all students. An
optometrist performed dry manifest refractions on all students who
failed the initial vision screening. Consent forms for students who
required glasses or a referral to a pediatric ophthalmologist were sent
home with students by school nurses. In addition, SDP employees
mailed consent forms directly to parents. Each consent form was
marked with an “N” for those sent home with students (n=413) and
“W” for those mailed directly to parents (n=826). Differences in
return rates of consent forms using these methods were compared.
Results: A total of 2775 students age 5-12 years were screened. Of
those, 413 students(15%) had a refractive error correctable with
prescription glasses, and 290 students(70%) returned consents
allowing 2 pairs of glasses to be made for each student. A total of 136
students(5%) were referred to Wills Eye pediatric ophthalmology for
evaluation of conditions such as amblyopia, hypermetropia, myopia,
and monocular exotropia. A total of 58 students(46.2%) returned
referral consent forms and 27(46.6%) students completed an eye
exam. Of the 315 total consents returned, 267(84.8%) were originally
sent home with students and 48(15.2%) were received from those
mailed directly to parents.
Conclusions: The Wills Eye Vision Screening Program for Children
was able to identify and provide glasses to elementary students in the
SDP. Consent forms sent home with students yielded a higher return
rate than mailings, indicating this method is preferred.
Therefore, all future consents will be sent home with students
during school. Vision screening programs should consider additional
strategies, such as telephone calls, educational programs, or
incentives, such as movie or museum tickets, to improve consent
return rates to enhance follow-up pediatric eye care.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Commercial Relationships: Judie Tran, None; Lisa A. Hark,
None; Harjeet Sembhi, None; Melanie Snitzer, None; Vinit
Awatramani, None; Angela Rice, None; Micheal Pond, None;
Shayla Stratford, None; Deiana M. Johnson, None; Alex V. Levin,
Pediatric Ophthalmology and Ocular Genetics (E), The Foederer
Fund (F), The Robison D Harley MD Edowed Chair (E)
Support: Deerbrook Charitable Trust
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].